Royal Assent

Baroness Hayman: My Lords, I have to notify the House, in accordance with the Royal Assent Act 1967, that the Queen has signified her Royal Assent to the Criminal Justice and Immigration Act.

Housing: Home Information Packs and Condition Reports

Baroness Sharples: asked Her Majesty's Government:
	How many (a) home information packs and (b) home condition reports have been commissioned.

Baroness Andrews: My Lords, the commercial and private nature of a home owner's decision when to place their property on the market for sale means that we do not hold information on the number of home information packs and home condition reports commissioned. However, from 1 August 2007 to 1 May 2008, 642,551 home information packs have been produced; and, to the beginning of May, 1,776 home condition reports have been lodged on the HCR register.

Baroness Sharples: My Lords, I thank the noble Baroness for that Answer. Is she aware that some inspectors are not earning the income that they were led to expect? For how many months does an HIP energy performance certificate last, especially in this very uncertain housing market?

Baroness Andrews: My Lords, on the first part of the question, the noble Baroness will know that we rolled out HIPs to all dwellings last December, which will create a significant demand for EPCs. I can also tell her that throughout the year there will be increasing opportunities. From 1 October, EPCs will also be required for private and social rented property on a change of tenancy and for sales of commercial property, so we will embark on a major communication campaign. Significantly, we are also finding that the industry is responding to the potential of the market-led, voluntary home condition report, and we are looking at examples that are coming forward to complement that. So there is a lot of positive activity in the field. At the moment, the EPC lasts for a year but, following our consultation process, we are considering a range of options proposed by stakeholders and will come to a decision soon.

Lord Marsh: My Lords, this is a very interesting subject to practically everyone in the country. Would it be useful if a study was undertaken to find out how many people selling or buying a house think of undertaking a study themselves?

Baroness Andrews: My Lords, we conducted area trials to anticipate the rollout and found that most people who took part found that the information was what they wanted. It is an evolving process. We have been as flexible as possible; today, we are laying amending regulations to extend the period of flexibility for first-day marketing and in relation to leasehold information, because that is complex. That is what the industry wants, and that is what we are doing.

Lord Campbell-Savours: My Lords, will my noble friend expand on what she means by change of tenancy?

Baroness Andrews: Yes, my Lords. In the private rented sector, when the change is introduced, EPCs will have to be produced on a change of tenancy. That does not mean that an energy performance certificate will have to be commissioned every time the tenancy changes. At the moment, the EPC lasts for a year, but, as I said, the consultation process suggested that it should last for longer, and we are considering that. It is right to include the private rented sector because so many people need to know what their energy costs would be when they change tenancy, even if they are renting.

Baroness Maddock: My Lords, the Minister will know that the report of the pilots came out after the rollout of this operation. Fifty-eight per cent of buyers did not agree that home information packs had speeded up the buying process and more than three-quarters said that the HIP had no effect on their decision to purchase their property. In the light of this, and given what the Minister said today, when can we expect a proper evaluation of this whole costly bureaucratic process?

Baroness Andrews: My Lords, it is not costly or bureaucratic. The EPC on average costs £300, not the £1,000 that was anticipated. It is giving people information for the first time about the costs of their energy when they move home. Thirty per cent of the people who took out HIPs said that they were going to act on that information. We do have a problem in that estate agents are not always letting buyers know about the HIP or what it contains. That is why we are now working closely with the industry. We have a stakeholder group that represents the whole of the industry and consumers to ensure not only that people get the information they want but that the HIP itself is enhanced with consumer-friendly information. This is work in progress—we have never made secret of that—but it will help the market and the buyer.

Lord Dixon-Smith: My Lords, I understand that yet another order is coming forward that will extend the date so that the first-day exemption, which permits a seller to sell their house without a home information pack, in effect defers the full implementation of this programme once again. It really is time that we began to look at the end of this farce. Would it not be much better to focus everyone's attention on the energy and efficiency reports for individual homes, which are essential and very helpful to everyone, even to people who are not moving house, and would be much more beneficial to the whole community, and to end this nonsense which the vast majority of sellers of houses do not find helpful? I agree that it is not very expensive, but it is beginning to waste a great deal of everyone's time.

Baroness Andrews: My Lords, the noble Lord is quite right. He is a champion of energy performance certificates, which do an important job. However, the home information pack is serving a purpose. The interesting thing is that as the process beds down—and it has been successful; nearly 700,000 HIPs have been rolled out—the industry is coming forward to see what is possible and how HIPs can be improved in relation to a home's condition. The noble Lord shakes his head, but I assure him that we are working with people such as RICS and SAVA to make the most of the opportunity. The changes that we make today are in response to the certainty that industry says is important at this time to extend the process of flexibility of first-day marketing.

Lord Lea of Crondall: My Lords, I assure my noble friend that despite the impression created in some quarters that home information packs have no friends in the country at all, these are very widely seen as an enormous advantage in dealing with estate agents, who are not normally known for putting the whole truth on their prospectuses. History will show that a variation of the present home information pack, if not the exact one, is here to stay, and the professionals in the industry really ought to start to get behind it and realise that it is in the interests of everyone in lubricating the buying and selling of houses.

Baroness Andrews: My Lords, my noble friend is quite right: the point is that the industry is now behind it. There is no doubt about that. We have seen what we thought would happen; the introduction of HIPs is driving changes across the market. For example, the cost of searches has gone down on average by £30 and in some instances by £120. As I have said, we have 700,000 energy performance certificates. People are acting on those changes, and, at a time when energy bills are inevitably going up, how much better it is that we give them information on which they can bring down their costs.

Baroness Gardner of Parkes: My Lords, can the Minister tell me how they will work in blocks of flats?

Baroness Ashton of Upholland: My Lords, we are in the ninth minute.

Prisons: Titans

Lord Ramsbotham: asked Her Majesty's Government:
	When they expect to find a site, and apply for planning permission, for the first of the three planned Titan prisons, announced on 5 December 2007.

Lord Hunt of Kings Heath: My Lords, site searches are currently under way. We will apply for planning permission when a suitable site has been identified.

Lord Ramsbotham: My Lords, I thank the Minister for what can only be described as a remarkably thin reply. On the same day that the report of the noble Lord, Lord Carter of Coles, was published, the Times published a diagram of one of these monsters. It contained a series of three radial wings five storeys high to hold over 2,500 people. I understand that the firms that submitted these designs were invited to help solve today's crisis by housing as many prisoners as possible as cheaply as possible. Can the Minister explain how that direction squares with the frequently voiced opinion that the Government are trying to protect the public by providing conditions and treatment for prisoners that are designed to prevent reoffending?
	My Lords, the proposal is for three Titan prisons. The point of the Titans is that by investing in them, we will ensure that we have first-class design, infrastructure and shared services, but within the campus of such a prison there can be smaller units. In that way you get the benefits of large-scale investment together with the benefit of being able to manage smaller units within the campus. As part of taking Titans forward, we want to continue to improve the record on offender management programmes. The noble Lord may have forgotten that there has been strong investment in our prison services and offender management programmes over the past few years.

Lord Henley: My Lords, in February the noble Lord promised us a consultation on these so-called Titan prisons, and I think that it was supposed to come out in April. I have been through the department's website very carefully but I can find nothing whatever about the consultation. Is this yet another bit of consultation from the Government, or at least from the noble Lord's department, that is to be deferred again and again?

Lord Hunt of Kings Heath: Not at all, my Lords. We are going to publish a consultation in the near future. It will enable all interested parties, including noble Lords, to have a look at the proposals, and I am sure that we will take great care in taking account of the views expressed. It is better to get it right. If that means that the consultation comes out a little later, in terms of the final outcome, that is well advised.

Lord Woolf: My Lords, is it still the policy of Her Majesty's Government to advance the principle of community prisons so as to meet the need for prisoner management and, if not, why not? If it is, how can the use of Titan prisons be said to be consistent with that policy?

Lord Hunt of Kings Heath: My Lords, it needs to be remembered that the proposals for Titan prisons will be developed particularly in areas where prisoners are held at quite long distances from their homes. This will enable us to ensure that prisoners are held much closer to their homes. Developing Titans will also enable us to rationalise and further invest in the current stock, which may well provide some of the facilities referred to by the noble and learned Lord.

Baroness Falkner of Margravine: My Lords, given the vulnerability of young people in the criminal justice system, can the Minister tell the House whether he has determined a minimum age for those who might be housed in these Titan prisons?

Lord Hunt of Kings Heath: No, my Lords. We debated youth justice extensively during the passage of the Criminal Justice and Immigration Bill, which received its Royal Assent today. The noble Baroness knows that we see custodial sentences for young people as very much the last resort, but they are necessary for some young offenders. Our aim is to make sure that the conditions and circumstances in which they are held in custody are geared towards the prevention of reoffending. We will continue with that aim.

Lord Dubs: My Lords, is my noble friend aware that the optimism with which he describes the way in which these Titan prisons will work is not confirmed by the experience of other countries? For example, the advice that has come from France is that it will not build any more because they do not work. Can he further explain his earlier comment that these large prisons would enable prisoners to be near their families? I do not understand how that would work. Surely large prisons, by definition, have larger catchment areas and therefore the distances from prisoners' families must be greater.

Lord Hunt of Kings Heath: My Lords, there is a particular shortage of prison places in the south-east, the West Midlands and the north-west. By providing more facilities in those areas we will enable prisoners to be located closer to their homes and families. The point about whether Titans will work effectively is surely this: we already have three clusters in this country where a number of units are located close together and are being moved towards a single management structure. There is very little difference between that and the concept of Titans.

Lord Elton: My Lords, it is very different from the model of Titans published under the Ministry of Justice logo shortly after it appeared on television on 11 December, which showed one monolithic building and a small football pitch. What is the status of that particular design and how will the one small football pitch provide exercise for 2,500 prisoners and accommodation for the enormous number of visitors whom they can expect?

Lord Hunt of Kings Heath: My Lords, much as I admire the Ministry of Justice website, one should not take one diagram and assume that that is the model that is set in stone. The noble Lord, Lord Carter, proposed a number of approaches and visions of how this programme might be developed. Essentially, it allows several categories of prison and different regimes within one perimeter. As I have said, that means that you get the benefit of large-scale investment, better design, better infrastructure and the cost-effective benefit of shared services; and with the smaller units within it you get the benefit of closer attention between management, staff and prisoners.

Corruption

Baroness Williams of Crosby: asked Her Majesty's Government:
	What plans they have in the near future to support the bribery and corruption working group of the Organisation for Economic Co-operation and Development.

Lord Tunnicliffe: My Lords, the United Kingdom is fully committed to the fight against international corruption. We continue to work closely with the OECD on improving our anti-bribery procedures and helping to raise standards across the membership of the working group on bribery—indeed across the globe. The UK is a founder signatory of the 1997 OECD Convention on Combating Bribery of Foreign Public Officials in International Business Transactions and has been represented at every quarterly meeting of the working group.

Baroness Williams of Crosby: My Lords, the comment about a full commitment may raise an eyebrow. In his distinguished report on ethical conduct for BAE Systems Ltd, the former Lord Chief Justice, the noble and learned Lord, Lord Woolf, recommended that,
	"the Government should quickly bring forward the necessary legislative proposals",
	to the OECD. Back in June 2000, the then Home Secretary, now the Secretary of State for Justice, commendably said:
	"Our overriding consideration is to clarify and codify the law in line with developments both in this country and internationally. Our focus is on the raising of standards in both public and private life".
	With commendable speed, the then Home Secretary brought forward a White Paper which adopted the Law Commission's proposals for a single bribery convention. That was eight years ago. Since then, there has been only one small change, in a provision on the bribery of foreign officials in the counter-terrorism legislation of 2002. Do the Government intend to meet their obligations and include a serious and comprehensive bribery law in the next Queen's Speech?

Lord Tunnicliffe: My Lords, we have been trying to bring forward a new law for some time. It has not proved an easy task, but it is vital that we get it right. We originally presented a draft Bill in 2003 but, despite having been widely welcomed until that point, it was heavily criticised by the parliamentary committee that considered its suitability for presentation to Parliament. A further government consultation in 2005 confirmed broad support for reform but not what form that reform should take.
	The Law Commission was therefore asked in spring 2007 to commence a fresh review and to prepare a new draft Bill. Its review is the best and most effective means of working out proposals for a new law. It published its consultation paper on 29 November 2007 and consultation closed on 20 March. We look forward to receiving its report and a draft Bill this autumn, and will seek to introduce new legislation as soon as parliamentary time allows.

Lord Hylton: My Lords, are cases related to corruption pending against British citizens in the Republika Srpska, a component part of Bosnia-Herzegovina which has recently completed a major privatisation programme?

Lord Tunnicliffe: My Lords, I do not have a brief on that specific question. We have many investigations in the UK, and 144 allegations of overseas corruption recorded by the SFO. The SFO has brought 15 foreign bribery inquiries and the City of London five more. Forty-four allegations are under preliminary investigation. The SFO has discontinued one inquiry, BAE-Saudi. Preliminary investigations on 35 additional cases were closed due to insufficient evidence. No action has been taken on 40. We have also provided additional funding to the City of London Police dedicated to the international anti-corruption group. We will nevertheless write on the detail of the question.

The Lord Bishop of Exeter: My Lords, I declare an interest as a trustee of Christian Aid, which, as your Lordships will know, is an organisation dedicated to the relief of poverty and the eradication of its causes—of which poor governance and corruption are among the most pernicious. Can the Minister say what engagement there is with the international development agencies to assess the impact of corruption on the world's poor and also indicate how our own legislative provision compares with that available in our EU colleague nations?

Lord Tunnicliffe: My Lords, the World Bank assesses that corruption costs more than 5 per cent of global GDP. About $1 trillion is paid in bribes, and corruption adds about 10 per cent to the cost of doing business globally. Corruption causes a 25 per cent increase in the cost of procurements in developing countries and has a negative impact on foreign direct investment that is equivalent to a 20 per cent tax. As for the United Kingdom's position in what one might loosely call the "league table" as determined by the internationally recognised standard of Transparency International, it is second in the G8 countries after Canada and twelfth cleanest of the 179 countries surveyed.

Baroness Whitaker: My Lords, following the question asked by the noble Lord, Lord Hylton, and declaring an interest as a member of the advisory council of Transparency International UK, may I ask my noble friend to clarify whether or not any prosecutions have been brought under our present legislation over the last few years?

Lord Tunnicliffe: My Lords, there have been a number of investigations, but I am not precisely sure of the answer. I will write to the noble Baroness on that point.

Crime: CCTV

Lord Harrison: asked Her Majesty's Government:
	What steps they will take to ensure that maximum use is made of closed circuit television footage as part of a strategy to reduce crime.

Lord Bassam of Brighton: My Lords, the national closed circuit television strategy was published in October last year and a national CCTV strategy programme board has been established. The programme board is currently reviewing the strategy's recommendations, and the Government will have the opportunity to approve the work of the board later this year.

Lord Harrison: My Lords, does my noble friend agree with ACPO's view that the contribution of CCTV cameras will be as significant as that of DNA and fingerprinting? In order to fulfil those ambitions, though, will he ensure that the cameras are properly positioned, primed, loaded with film and capable of producing images that can be recognised so that leads can be followed up? Will he ensure that the police who operate the cameras are properly trained, motivated and, where necessary, such as in viewing the footage, supplemented by modern and updated technology?

Lord Bassam of Brighton: My Lords, there are apparently some 4.2 million CCTV cameras in the United Kingdom, not all of them in the public sector. It is right to say that we need to make good and effective use of CCTV because it has an important impact on the detection of crime, the deterrence of crime and the reduction of the fear of crime. The issues that the noble Lord raises regarding training, motivation of staff and improvements in technology are the right ones to address, which is why we have a developing national strategy, many of the recommendations from which address those very issues.

Baroness Gardner of Parkes: My Lords, does the Minister know that Westminster Council finds CCTV extremely successful, but that it was said on radio recently that, on the whole, nationally they are a waste of time? Westminster's answer was that people need the time to look at the films. Will he confirm that that will be one of the factors taken into account?
	When I was mugged—not in Westminster—none of the cameras nearby was recording as they either had no film in them or were not working. No one can look at things if they are not recorded.

Lord Bassam of Brighton: My Lords, I am sorry to hear that the noble Baroness was attacked in that way. That is appalling. CCTV can make an important contribution to dealing with incidents like that. I am a CCTV enthusiast; when I was city leader in Brighton, I led a campaign to have CCTV networked across the city. It has an enormous benefit and value, particularly where there is a big night-time economy. It is important to ensure that the cameras are operational and are working properly and efficiently, and that the staff looking at them know exactly what they are looking for. That is an important element in the training programmes that are being designed as part of the national strategy.

Baroness Miller of Chilthorne Domer: My Lords, the Minister's enthusiasm for CCTV seems to ignore the evidence from the 2004 Home Office study that only one in 14 CCTV systems that it studied in great detail actually had any effect on the rate of crime. Would it not therefore be better to put more effort into getting police on the beat and less into CCTV?

Lord Bassam of Brighton: My Lords, it is not a case of either/or; it is a case of using CCTV intelligently along with neighbourhood policing and community support officers on the ground so that they can work together. Most CCTV control rooms ensure that the controller there has a radio connection with police in the field and can advise them on particular problems in order to deal with the sorts of low-level disorder that CCTV can easily pick up.

Lord Selsdon: My Lords, I have asked this question before, and I think that the Minister's figures are way out of date: how many CCTV cameras are currently registered with the Information Commissioner?

Lord Bassam of Brighton: My Lords, I do not have those data. The figure I have of CCTV cameras operable in the UK is an estimated number.

Lord Campbell-Savours: My Lords, following the Joseph Sebastian case, over which there are question marks and which was referred to the Criminal Cases Review Commission, is there not an argument that prosecution authorities should not use speeded-up versions of CCTV material in court because that may well influence cases in a way that is prejudicial to the person being tried?

Lord Bassam of Brighton: My Lords, there have to be proper legal protections when using material obtained by CCTV: I do not think any of your Lordships would argue with that. The important thing is to ensure that if CCTV is to be used in a courtroom, the quality of images is usable and that it provides additional information and evidence to that which the prosecuting authorities will, no doubt, provide to the court. Those issues are extremely important.

Baroness Hanham: My Lords, as the Minister has said, it is believed that there are more than 4 million CCTV cameras in this country. It is also assessed that we are the most surveilled country in Europe and, indeed, in the wider world. Are the Government at all concerned about the civil liberties aspect of that?

Lord Bassam of Brighton: My Lords, if I had to debate with the noble Baroness, I could fairly argue that I am one of those who are civil libertarians. Yes, of course, one has to get a balance between protecting civil liberties and ensuring that we provide proper protection on the streets from the very people who attacked the noble Baroness, Lady Gardner of Parkes. That is the exact issue we need to grapple with, which is why operational manuals and codes of practice are, importantly, in place. Those things ensure that liberty protections are, rightly, balanced against the need to protect people.

Lord Harrison: Yes, my Lords, but does my noble friend not recognise that the tenor of questions following my original one demonstrates that, if we are to have CCTV cameras among us all, they need to be properly used and manned so that we can get the benefits that are clearly available when those conditions apply?

Lord Bassam of Brighton: My Lords, I entirely agree with my noble friend. That is why the national strategy is addressing the issues of quality, training and motivation and ensuring that we take maximum benefit from improvements to digital and other technologies relating to CCTV.

Business

Baroness Royall of Blaisdon: My Lords, with the permission of the House, after the first debate today my noble friend Lady Crawley will repeat a Statement on the cyclone in Burma. I should also take this opportunity to advise the House that, if Back-Bench contributions to the final debate, in the name of the noble Baroness, Lady Finlay of Llandaff, are kept to nine minutes, we should be able to rise tonight around the target time of 7 pm, and that the timing for the first debate, in the name of my noble friend Lady Massey of Darwen, is extremely tight. Noble Lords contributing to that debate should sit down before the clock says 12.

Business of the House: Debates Today

Baroness Ashton of Upholland: My Lords, I beg to move the first Motion standing in my name on the Order Paper.
	Moved, That the debate on the Motion in the name of Baroness Massey of Darwen set down for today shall be limited to three hours, and that in the name of Lord Bilston to two hours.—(Baroness Ashton of Upholland.)

On Question, Motion agreed to.

Draft Financial Assistance Scheme (Miscellaneous Provisions) Regulations 2008

Baroness Ashton of Upholland: My Lords, I beg to move the second Motion standing in my name on the Order Paper.
	Moved, That the Draft Financial Assistance Scheme (Miscellaneous Provisions) Regulations 2008 be referred to a Grand Committee. 18th report from the Joint Committee on Statutory Instruments.—(Baroness Ashton of Upholland.)

On Question, Motion agreed to.

Children's Plan

Baroness Massey of Darwen: rose to call attention to the Government's Children's Plan (Cm 7280) and its implications for equality of opportunity; and to move for Papers.
	My Lords, it is a great pleasure to introduce this debate, and I look forward to speeches from all sides of the House, from the array of talent that has agreed to speak. Truly, this is an impressive list; all are committed to the well-being of children and have experience of promoting equality of opportunity for children.
	When we discuss issues related to children in this House, it is always invigorating and moving. We are all genuinely concerned, including my noble friend the Minister, for children and their welfare beyond party politics. That was evident in recent discussions—vigorous ones, I might add—around the Children and Young Persons Bill. The Minister proved his patience and skill by obtaining many changes to that Bill, much to his and everyone's credit, and to its improvement.
	I should declare an interest as chair of the All-Party Group on Children; I am also a school governor in London. The all-party group has a large membership, partly from the voluntary sector, and I want to pay tribute to them for their tenacity in seeking the best for children and for the excellent briefings and discussions that they instigate. I also pay tribute to the Children's Commissioner and his office for their continuous highlighting of issues significant to children and families. They held a wonderful reception yesterday in the Cholmondeley Room, where children gave presentations on what makes them healthy and happy. Again, it was shown that listening to children matters.
	All of us here today believe that the well-being of children should be a key aim for any society. So, I believe, is equality of opportunity, and that starts early in life. The Children's Plan rightly puts parenting at the heart of children's welfare and achievement. We need to raise expectations and standards for all but focus on particular need, be it to do with gender, race, sexuality or disability. These are deep-rooted issues which no one initiative can tackle. This Government have done more than any other, I believe, to support children and families. There has been real progress towards equality. The Children's Plan is an ambitious, visionary and exciting document. It builds on previous initiatives such as Every Child Matters and has been developed in consultation with children and young people, parents and experts, and consulting is, I believe, a cornerstone for producing measures which truly respect equality of opportunity by respecting people.
	I give two and three-quarter cheers to the Children's Plan, which is not bad. I would give three cheers if the concerns I shall express today were met. I cannot, of course, go through the whole document today and I know that other noble Lords will raise specific issues. I shall talk about implementation of the plan and refer also to the primary school curriculum and leisure facilities. More of that in a moment but, first, I want to focus for a moment on the Government's record on supporting children and families—and this does deserve three cheers.
	The total spend on education rose from £29 billion to £64 billion between 1998 and 2008—a massive increase of £35 billion. There are around 2,500 Sure Start children's centres offering services to almost 2 million children and their families. More than 10,000 schools provide access to extended services in conjunction with local providers. All this strengthens community services. Total funding on children in schools has risen from just under £3,000 to just over £5,000—an increase of £2,520 or 87 per cent. There has been a large building programme for schools. Academic results have improved. For example, the number of schools where 70 per cent or more pupils gain five A to C GCSEs has risen to 891, up from 83 in 1997—a tenfold increase. Teenage pregnancy rates, thanks to a deliberate focus on this issue, are at their lowest for 20 years—the under-18 rate falling by 13.3 per cent and the under-16 rate by 13 per cent since 1998.
	Some will say that there have been too many Bills, White Papers, plans and policies around children in recent years. The noble Baroness, Lady Howarth of Breckland, a great stalwart of children's services, cannot be here today. She is, together with a few others who would have had something to say, at an EU meeting somewhere on a boat. I know her views because we have discussed them. She would have said, "I don't want to see any more plans. I want implementation and proof of it". She went on to say that if one-tenth of this Children's Plan were implemented, it would be a great achievement. I stand here today to praise the Government's record on the well-being of children but also, I hope, to open up an honest debate on the implementation of this plan.
	UNICEF and other children's organisations share the concern about implementation, as does the House of Commons Select Committee on Children, Schools and Families. They point to a lack of priority among objectives and the absence of a timetable for implementation. They point out that in long-term planning it is important to stick to objectives. There are now three sets of indicators that the DCSF is using: five Every Child Matters outcomes; six strategic objectives; and five PSA objectives. This will be very confusing. I hope, as does that committee, that this will all be clarified when the progress report promised by the Government appears in a year's time. Perhaps the Minister can clarify that for us.
	Achieving some measurable goals by 2020 seems a long way off and surely some improvements could be apparent quickly. I think, for example, of children in care and children in custody. There are not great numbers of these children and surely we could focus efforts here to achieve speedy results. I am aware that much is being done but can the Minister give me some reassurance that clear priorities will be set and some precise interim objectives set out for the Children's Plan within the year? I cannot, as I said earlier, cover the scope of the plan in the short time available, but some central themes follow government initiatives closely: tackling poverty, placing families at the centre of integrated services, the extended role of schools, the role of children's trusts, a guarantee of play facilities, and higher educational standards. This will all be familiar and has clear relevance to equality of opportunity.
	A few highlights from the Children's Plan for me are the emphasis on parenting and the introduction of parenting advisers in every local authority and the improved Outreach for Sure Start centres. Outreach often works better than a single-site service alone, however good it is. The plan introduces Family Pathfinders, especially for young carers. At last, maybe, these extraordinary young people may get some benefits and more support. There is a commitment to better short-break facilities for disabled children—a welcome inclusion. There is a promise of new playgrounds and new adventure playgrounds in deprived areas. How often do we hear from young people that they have nowhere to go and nothing to do? We certainly heard this from young people at the Children's Commissioner's reception yesterday. There will be a new child health strategy and a review of child and adolescent mental health services, action on bullying, personalised learning, a focus on gifted and talented, more attention to behaviour and discipline, encouraging meaningful staying on in education, managing risks, and sex education as part of programmes of social and emotional health. The Minister knows well that I always have said that this should be compulsory anyway. I will not go into that now. I welcome the prospect of a Green Paper on the education of young offenders. I know that the noble Lord, Lord Ramsbotham, will have something to say on that and I am grateful, as are we all, for his passion on that subject.
	Many concerns lie in deep-seated societal problems which no plan for children can solve, although it may contribute to solutions. But some issues really should be able to be addressed instantly. I have mentioned children in care and young offenders. Let me now look at leisure facilities. Yes, let us build more, but let us engage with young people in what we have—for example, local sports clubs. This happens, of course, but local clubs could tell many a story of planning problems. My noble friend Lady Billingham, who cannot be here today—she may be on the same Euro boat as the noble Baroness, Lady Howarth—would say that the issue of recreational facilities is bedevilled by atrophy in planning systems for clubs. Why should it take years to get floodlighting permission or permission to set up a club or build changing facilities or have nets for cricket? This is not my noble friend the Minister's area of responsibility but can he speak to Ministers who have this brief and try to inject a sense of urgency? Young people need recreational facilities in every community and communities are sometimes denied quick and easy access to setting them up. We are all concerned about youth crime. Why do we not try to engage young people at a local level in something different?
	Let me finally make a few comments on the primary curriculum. This is covered in chapter 3 of the Children's Plan. A review is announced to support seamless experience of education between phases. It will begin this year and report back by March 2009 so that changes may be implemented by 2011. Again I would ask: why so long? The review will better personalise learning and teaching while ensuring grounding in the basics. It will seek to raise standards in all pupils through a number of measures, including a strong focus on learning and numeracy, on scientific understanding, on the effective use of ICT, on reducing prescription to allow for building on previous learning, on the availability of the creative arts, sport, humanities, science and technology, personal, social and moral education, and on more learning outside the classroom.
	This is all well and good—in fact it is excellent—but will the issue of testing in primary schools be addressed? I have long thought from my experience as a former teacher, parent and school governor that testing too often and too early can be counterproductive. It can distract children, teachers and parents from what education is really about, which is stimulating curiosity and love of learning.
	I had the great pleasure recently of interviewing for the House Magazine that wonderful children's author Michael Morpurgo. He was emphatic that children should enjoy literature, with an encouragement to explore books and be entertained by them; a sure way to encourage reading. He thought that there should be an academy for literature. Perhaps my noble friend will take that on board. The joy of learning is the best way that we can encourage young people to maintain a lifelong interest in learning. I certainly do not want to create a generation of stressed children who regard learning as a means to passing tests.
	I have expressed concern about the implementation of the Children's Plan and the setting of objectives. I suggested that it is possible to do some things more quickly. I have touched on play, recreational facilities and primary school testing. We need to be clear about what is important, what is already half-there and quickly achievable and what is really long term. Some things are urgent, such as youth justice and children in care.
	I anticipate with great pleasure the words of others who will expand on my brief statement. One of the reasons for such debates is to keep children and young people on the political agenda. Not that I think that the Government will let this slip; but let us encourage them during and following this debate to bring together all their excellent initiatives and prioritise, plan and have a strategy that is timed. Let us press for a clearer timetable and a tighter implementation strategy. Can the Minister, if he agrees, try to work on that and report back to us? I look forward to the debate and to the Minister's response. I beg to move for Papers.

Lord Dearing: My Lords, it is a privilege to follow the noble Baroness, whose speech showed such knowledge and such caring, while focusing on the practical issue of implementation, which is the most difficult and important issue. I will concentrate on one aspect of the Children's Plan; those children who fare and have fared least well in education for the whole time that I have been in this House and, I suspect, for a generation before that. It is a matter of shame that we have continued to fail so many of our children and condemn them to inferior lives for so long.
	I acknowledge without reservation what this Government have done to improve their lot. What is said in this plan gives one great encouragement. I would like to give it three cheers—subject to the implementation issue—but I have one or two reservations. I have no doubt about the commitment of the Secretary of State to disadvantaged children, because in six short paragraphs of his introduction there are six references to meeting the needs of every child and saying that no child should fall behind. That shows great intention, which I greatly welcome. However, unless we can achieve what he clearly wants to, we are condemning these children to impaired lives. Even if they want to go off the academic route into an apprenticeship, so much of an apprenticeship nowadays depends on them spending time in college, which depends on their ability to read, write and engage in high-level apprenticeships.
	In another context, apart from careers, I was speaking in a debate 10 days ago led by the most reverend Primate the Archbishop of Canterbury, in which I referred to the need for reading and writing skills to deal with the forms that we all have to live with from the Government and local authorities. I referred to the child tax credit application form. Imagine that you are a jobbing bricklayer with irregular income trying to answer a 12-page form. If you have a big family, there are another four pages. How many explanatory notes do you have to read? There are 59 foolscap pages of explanatory notes to complete the blessed form. One must be able to read and write to cope effectively in every aspect of life nowadays.
	So many proposals help us in this area, but I want to talk about the specific goals set in paragraph 35 of the White Paper's executive summary. I welcome the Government's intention to consult over them. If we are talking about objectives for 2020, we need a commitment not only from this Government but from all parties, because the worst thing for schools is to have to say, "They are changing it again". They need continuity so that they can address their energies to implementation rather than to the readjustment of starting on a new track. We need this period of consultation and to coalesce on an agreed series of objectives. I have one major reservation about them: they all refer to 2020. The issues of reading, writing and arithmetic, about which I have so much concern, cannot wait for 2020. It is urgent now for those kids' lives.
	I recognise that the PSA target for 2012 is not in the White Paper, but I suggest that the target set in the Children's Plan for achievement at the end of key stage 2 should be brought forward from 2020 to 2015 because it matters so much to the lives of these people. I did not see in the White Paper—I may have missed it—that there is not a target at 16 specifically for English and maths as opposed to all subjects where there is a target for five GCSEs at a decent level. I would like there to be one so that there is some explicit commitment to lifting what is achieved at the end of key stage 2 to 16 year-olds.
	I stick to 16 year-olds because that is long enough to wait for another target to be set. Those are my two main qualifications, although I would add that one or two targets are so unspecific that it would be difficult to judge whether they are being met. Perhaps that issue can be addressed during the consultation and more specific targets put in.
	I turn to specifics—one inevitably tends to ride one's own aged hobby-horses—and, first, to the extended school day. For children coming from disadvantaged backgrounds that is a key element in any commitment to rescuing kids from disadvantage. Middle-class parents can afford any extra coaching that their children need and have the money in their wallets to take them to enriching activities. The child from a disorganised, disadvantaged poor home cannot be offered those extras, but they can through the extended school day, especially in areas of social disadvantage. That needs to be a continuing high priority with the teaching resource allocated to obtain the best from it.
	The Nuffield Foundation has raised the importance of break time. It can be used creatively and I was glad to see in the plan the commitment to 3,500 refurbished playgrounds and to obtaining several thousand qualified playworkers. I regard that as part of the kind of service that schools can offer to children from disadvantaged homes in particular.
	I again touch on my hobby-horse of summer-born children. I am glad that that has been picked up in the White Paper. While I accept the comment in it that, if it were offered, parents would hesitate to take the advantage of starting a year later because the pupil would lose a year's schooling, by the time that took effect, schooling would be compulsory until 18 years of age, not 16; it would not be such an issue. We could offer the child and the parents an entitlement to have the extra year. I would not see that as a disadvantage and, in the light of experience, it deserves to be on the agenda.
	I would like to say a word about the tutors proposed for every child throughout his or her school years. That is excellent. They need someone who knows them and to whom they can go. But at a couple of schools that I recently visited I picked up the idea of a tutor group of children of different ages, whereby the youngsters have a buddy who they can turn to in the playground or wherever, if they are in trouble. It is a useful concept. I have seen how the little group comes together, say, once a week; they get to know each other and help each other. The tutor group is a useful extension of the tutor idea.
	I have spoken previously about the important issue of managing well the transition from primary to secondary school. At a point when so many children move from a small school, where they are personally known and have a "good shepherd" teacher who looks after them, into a school that is two, three or four times as big, with no good shepherd, and when they are already behind, they have had it. I fear that that happens all too often. Therefore, the issue of transition for those who are behind is crucial. The White Paper speaks of a curriculum with continuity. That is excellent and is essential for languages, for example. But we have to address this issue beyond that. It is a question of melding the two teaching styles of primary and secondary, whereby, in their last year at primary, pupils begin to have experience of moving to another teacher in another classroom. Reciprocally, at the secondary school, they spend perhaps a third to a half of their time with one teacher who becomes the good shepherd in the first year, when the level of learning is not all that elevated. The issue of transition is important to meet the needs of, and show a good pathway to, those who are disadvantaged.
	What is said about excluded children, who are among the most disadvantaged, especially if they have problems of attitude and the way that their minds are made? These people really need money spent on them.
	I say in conclusion that it is important, when you are investing all of this money on particular things, to make sure that the schools spend it in the way that you want them to spend it, and it does not go to other objectives driven by the performance tables—which is all too likely to happen. I do not know how to work that trick, but we must tackle that. This is a great White Paper. If we can work on it together, it will be greater yet.

The Lord Bishop of Norwich: My Lords, I am grateful to the noble Baroness, Lady Massey, for calling this debate and for focusing upon equality of opportunity for children. This means not simply equality of opportunity to succeed in later life but opportunity for children now to enjoy their childhood and to play, for those from secure homes with anxious parents, to take risks and, for those whose homes are already risky, to experience some security.
	I am never quite sure in a debate like this whether I should declare interests, but we all have them. I am a parent in a diocese with more than 100 church schools, a co-sponsor of an academy, and I have associations with many children's charities. I suppose that the most dangerous of those interests is being a parent, and I am glad that my children are not here to listen to me pontificate about children.
	One refreshing feature of the Children's Plan is that it says clearly that parents and families—not Governments—bring up children. That that this might need to be said at all would have seemed ludicrous once, but at least we can be grateful for it now. It puts the rest of the plan, which I welcome—as did the noble Lord, Lord Dearing—in perspective. We know that what happens at home has a massive impact on children's education. We all know of some children who overcome a dysfunctional or inadequate upbringing remarkably—but many do not. The focus on parents is welcome, and to do so in the context of extended school provision seems right. I agree entirely with all that the noble Lord, Lord Dearing, has just said—especially since surveys of parents consistently show that they desire the co-locating of services, especially when these are available on a drop-in basis.
	I shall confine my remarks to the value of the extended schools programme, but I will refer also to the Children's Trust model, whereby the local authority commissions services for families and children from a diversity of providers. It is a very good model, but it involves a change in the local authority mindset that is not yet evident everywhere. I want to talk also about the social contract between parents and schools envisaged in the Children's Plan, which must be easily the most interventionist proposal that it contains.
	One key theme that has emerged from evidence submitted to the Children's Society's Good Childhood inquiry has been the need to develop personal and social skills—one of the main aims of the Children's Plan itself. I hope that this will be recognised in the review of the primary curriculum, since those early years in school are crucial for later achievement and confidence. The development of good communication skills is fundamental and the poverty deficit is not always one of parental income—it can be of parental engagement. Put simply, children whose parents do not converse with them, or children who are shouted at or are limited to passive receiving in front of a television or computer screen, are not well placed in our educational system. That is why the extended schools agenda is so valuable.
	I take two examples from church schools in radically different settings—one a rural primary in my diocese, the other a Church of England secondary school in Wigan, featured in an article in the Guardian this week. The Hesketh Fletcher high school has around 800 pupils. Nearly half of them come from the Hag Fold estate and many have serious problems coping with school life. At least 50 of them were in danger of permanent exclusion. Last November, Phase 1 Base was created—a flat on the estate, away from the school, that is well equipped and well furnished, with a living area, computer rooms, places for quiet learning and places for eating: a home, really. Here, children who are among the most alienated from education learn with a high teacher/pupil ratio—about one to six. House parents take over from teachers at the end of the school day and a meal is provided, with everyone gathered around one table, before homework is done. There is a chance to develop a different rhythm in life. This sort of home from home may be new, but it is not designed for the cotton-wool kids from risk-averse homes—it is for children from risky homes, where drug addiction, unemployment, casual violence, mental illness and parental imprisonment are common.
	One striking thing about the Good Childhood inquiry is that when children themselves are consulted, many who have not experienced a good home have more than an inkling of what it is—70 per cent say that loving parents in a good home is what makes childhood happy. I suppose that one thing that we have to do in relation to our extended schools programme is to introduce more children to the idea of what a good home is like.
	However, there is another side to all this, as the Good Childhood inquiry has revealed. While one group of children needs security, others are overprotected. A quarter of all children aged between 11 and 15 have never been to the park or the shops on their own. That is where I think a constructive strategy on the value of play—especially outdoor play, which enables children to achieve independence in life—is good, and the Children's Plan recognises that.
	The other school that I want to mention is in my own diocese. It is in Stibbard outside Fakenham—a village of just a few hundred people. It is a completely new church primary school, opened a couple of years ago, and has been deliberately sited in its rural location to ensure continuing vibrancy of life in a rural community. Attached to the school is a well equipped children's centre, which provides childcare and is also the base for a host of extended school activities. One big success story has been the African Drumming Club—just what you would expect in the Norfolk countryside. It has a set of 30 drums and parents and children are actively involved. One crucial thing in the extended schools programme is that it is a question not just of occupying children outside the normal school day but of engaging parents and children together in constructive activities—something that does not take place in the way that it should even in some of our more secure homes. The parents at the Stibbard school were consulted recently and they said that they wanted more sports-based and arts-based extended activities. If there is an issue, it is that the care provided through the children's centre has to be paid for, whereas much of the extended schools programme is free or at nominal cost, and that creates a tension between the children's centre and the school. In addition, some of the families which most need the provision—for which grants may need to be gained—may be the most reluctant to seek it.
	That raises a wider problem, which I ask the Minister to address. My question is: what happens with parents who themselves had problems at school? Many parents were alienated from education in their youth and see school, at best, as irrelevant or, at worst, as a threatening environment. When all this support is associated with the school, will those parents access it so readily when it is focused on what they consider to be a threatening environment? I should be interested to know whether research is being done into whether the extended schools programme is successful in drawing hard-to-reach families into its ambit or whether, as I suspect, it exacerbates social exclusion. I applaud the intention but recognise that there are real difficulties here as well.
	There is certainly a welcome from these Benches for the Children's Trust model, but local authorities need to manage the balance between their role as a commissioner of services and their role as a provider among other providers. The diversity of provision, which I see as being behind this model, is significant, yet it is very tempting for local authorities, which themselves may be funding small projects run by charities or churches within children's centres, to incorporate that fully into their own provision by taking on the workers as local authority employees. That may seem administratively efficient but it means that there is much less diversity of ethos and provision. That is not the way to foster creative partnerships and it seems rather statist in character. There are a few stray signs of this around and they could become a worrying trend.
	Finally, the social contract between parents and schools is a prescriptive intervention in a plan that focuses on supporting parents and families and could be a rather significant imposition on the day-to-day running of schools. I realise that the Government intend to consult on this but there is a lack of reference here and elsewhere in the Children's Plan to consultation with children and young people. That has been one of the real strengths of the Good Childhood inquiry because what worries children may not be self-evident to parents and teachers. For example, in that inquiry, a third of 2,500 children said that their biggest worry about school was bullying. That seems a very significant statistic for us to consider—that a third of our children are scared of being bullied in school. So any consultation on the new relationship between parents and schools must include children and young people themselves.
	I welcome the talk in the Children's Plan of developing a family policy for the 21st century—the introduction of a personal parent-held record from birth to age 11 seems emphatic in its symbolism of the emphasis on parents raising children, but there are still a few statist tendencies around, which I hope the Minister will endeavour to limit.

Baroness Howells of St Davids: My Lords, I, too, thank the noble Baroness, Lady Massey, for bringing this debate on the Children's Plan to the Floor of the House. I welcome the opportunity to comment on some of its details, with particular reference to equality of opportunity. Like the noble Baroness, I looked forward to reading the report and from an initial reading of its chapter headings, I hoped for new and innovative ways of keeping children and young people on the path to success. However, certain parts of the report impel me to ask some questions of the Minister.
	The report tells us that experts have highlighted that the curriculum should help children move seamlessly from nurseries to schools. However, at no time did it show how the four points highlighted by Sir Jim Roper will impact on what has already been done in schools.
	The report also refers to personalised learning that will put children and their needs first and suggests moving to a more sophisticated approach to be made standard practice across the system. However, in multicultural Britain, will the resources be available to meet the needs of each child or will we, yet again, have to change course? The aims described within the report are noble and worthy. We know there has been some progress but will it be sustained, and, if so, assessed in all schools?
	The report refers to parents as partners in learning—again, a noble aim—but says nothing of how parents will be supported in this type of involvement. There have been previous such initiatives but a high percentage still remain outside the loop. Will the Minister say how this will be managed in any future plan?
	The report refers to the best start in early years—how will this be achieved in practice? Even with Ofsted, children are still failing in large numbers. There are large gaps and only a small percentage appears to benefit. The report tells us that key stage 1 teachers and early years practitioners should look together at the early years foundation stage. This is common practice in some schools, but in all too many, it becomes a bolt-on. How will it be enforced?
	The report speaks of stimulating new talent, of different paths to the same ends, but how confident will teachers be in developing a curriculum and delivering it? Again, there is reference to ongoing assessment. However, should we not be careful that there is not too much assessment and not enough training to achieve good quality teaching?
	Reading through, one can be lulled into thinking that this is all very good, but questions remain. With classes where as many as 15 languages may be spoken, lifestyles are different and are often outside the teacher's experience, can any school deliver all these aims? If not, what percentage would be seen as acceptable?
	On box 3.5, which comes later in the report, if we take out the obvious reasons, the question still remains: why do schools continue to have children who need to catch up? How will what is proposed in this report achieve better results than the things that already happen in schools? Can we tackle underachievement in specific groups? It is difficult to see how this will be different. The schemes aimed at tackling barriers fail to take into account the sorts of children whom the teacher meets in the classroom each day.
	We are told that schools found the reading recovery programme much too costly and stopped the practice, even though some had trained teachers for this service. The projects in the main ceased to exist soon after the training of the teachers.
	The report talks about smooth transition, but how will the plan help summer-born children to close the gap? I fail to see any reasonable access for those children.
	On gifted and talented children, I have met teachers who say that, although this is talked about, there is no great impact on the children themselves or on the schools. Because of my background, I see education as the only means of upward mobility.
	The report, although beautifully presented, will in my opinion do little to achieve its goals. It has merely rehashed some of the things that have already been tried, so my last question is: who trains the trainers?
	I trust that my contribution does not sound too critical, but I feel that the authors did not quite understand the need to recognise the real differences in cultural backgrounds, which must be considered as one provides educational experiences for all children. Differences need to be identified and addressed.
	Let me highlight some other points. First, communication is often neglected; teachers and children are not communicating. Secondly, we need to look at how society itself impacts on children. Thirdly, we need to look at who goes to work and who nurtures the children at home. The sexes, the space, the time, learning, recreation, protection and the materials that are used in the school are all points that need to be considered and consulted on before a plan is drawn up. Even the make-up of the panel needs to be looked at.

Baroness Young of Hornsey: My Lords, I congratulate the noble Baroness, Lady Massey, on securing this debate, which is, after all, about planning for the future well-being of the country. I support wholeheartedly her remarks about implementation and incremental change. The DCSF has produced what is in many respects an effective analysis of the challenges faced by children, carers, parents and educators. It represents moves in the right direction in developing a strategy for helping our children and young people to enjoy a happy, secure and emotionally and educationally rewarding childhood.
	I should like to comment on three main points. The plan is rightly wide-ranging and ambitious but, in spite of appearing to be all-inclusive, it inevitably has gaps. First, it is quite right that the Children's Plan recognises that poverty blights the present and future lives of too many children and that changing that situation is essential. The need to continue to fight to reduce the number of children living in poverty is acknowledged as a key motivation for creating and implementing the plan. However, it is not only poverty that needs to be tackled. The plan says:
	"Particular groups, such as disabled children and those from black and minority ethnic groups, are especially likely to live in poverty".
	That is true, but it is also no accident. There is a set of complex reasons why that is the case, but racism and discrimination are hugely significant. It is not only the direct impact of discrimination on children that needs to be addressed. The plan states that in relation to further education:
	"The equality and diversity of the workforce is at the heart of the strategy".
	What are the mechanisms that will deliver on equality and diversity in FE—and, for that matter, elsewhere in the education system? We have struggled with that issue for decades and still not managed to achieve either real diversity or equality across many of the professions involved with working with children and young people.
	Race, disability and gender inequality blight people's lives too, and as a society, we have yet to identify the discourse that will enable us to discuss those openly and honestly alongside the issue of social deprivation. I echo the noble Baroness, Lady Howells of St Davids: my concern is that such subjects—racism and other forms of discrimination—when not explicitly raised may be submerged and therefore not adequately addressed or factored in as issues that shape the experiences, attitudes and life chances of children and young people.
	Secondly, despite the substantial work that museums, libraries, galleries and the performing and visual arts do with children and young people in all kinds of settings, I was disappointed to note that the only specific mention of the Department for Culture, Media and Sport that I could see in the plan related to play facilities. I should have liked to have seen the arts and culture entitlement for children and young people strengthened in the plan for a number of reasons. It can help children articulate difficult emotions and painful experiences in a safe way. It contributes to building self-esteem and a sense of self-worth. It can encourage teamwork and be the inspiration to achieve individual excellence. A wide range of transferable skills can be learnt that can lead to jobs in the cultural sector and outside it. Children and young people relish the opportunity to engage their imagination and creativity; they actually enjoy doing it. Some research has indicated that engagement with high-quality creative work can improve performance in both other areas of academic work, including literacy and numeracy, and behaviour and attitude in school.
	Clearly, the Government see the potential value of using the arts and culture in a variety of settings, and have invested substantial funds in the area. For example, the Find Your Talent scheme builds on the strengths and successes of the Creative Partnerships programme. Creative Partnerships enabled high-quality participation in arts projects in schools in some of the most deprived areas in the country. Related to this subject, the Care Matters action plan describes a pilot scheme on social pedagogy. That methodological framework, it is suggested,
	"provides a theoretical and practical framework for understanding children's upbringing. It has a particular focus on building relationships through practical engagement with children and young people using skills such as art and music or outdoor activities. It provides the foundation for training those working with children in many other European countries. In a residential care setting, it brings a particular expertise in working with groups and using the group as a support".
	I welcome that focus on trying to mitigate the negative impact on children and young people of being involved in the care system by injecting a fresh perspective on the role and remit of social workers. I look forward to seeing the results of the pilot scheme, and I will be interested to see whether there are other contexts in which it may be used to beneficial effect in addition to residential children's homes.
	The third gap that I point to briefly concerns refugee children. I am grateful to the Children's Society for a briefing on some of the issues raised by that omission. Those young people come under the jurisdiction of the Home Office, which immediately sets them apart as not our children but "others". It stigmatises them and identifies them as a problem. We need to safeguard those children as much as we would wish our own children to be safeguarded, because they are at their most vulnerable and disfranchised when they are locked into that system. We need to ensure that they are safeguarded and cared for; not treated as though they were actual or potential criminals.
	In summary, I am broadly in favour of the strategies laid out in the plan. Indeed, in some respects, it is hard to argue against many of the provisions and the underlying ethos. Who does not want our children to be happy and to have good lives? However, it poses a number of big challenges that it perhaps does not address wholeheartedly. For one, I struggle to see the coherence and consistency between stigmatising young people as thugs to be hounded and harassed in their homes to give them a taste of their own medicine, which I believe the Home Secretary intends to say today or has said, and some of the ethos and the feelings that are outlined in the various plans that we have been reading.
	Related to that, how do we bring together all these different components—the action plans, policies and strategies—that continue to emerge? How will we put together Every Child Matters, care for kids, Care Matters, theChildren's Plan and the forthcoming youth crime action plan to make a coherent whole, as well as integrating the rights and entitlements of refugee children to mental and physical well-being and security? Bringing all these areas together must surely be crucial to ensuring the effectiveness of the project overall. It is also absolutely essential to examine, to understand and to mitigate the impact of racism and all forms of discriminatory attitudes, practices and behaviours if we are really to get to grips with the problems that stalk some of the most vulnerable and disenfranchised young people in this society.

Baroness Warnock: My Lords, I join in expressing gratitude to the noble Baroness, Lady Massey of Darwen, and in congratulating her on calling your Lordships' attention to the plan for children. It is on the whole an excellent plan, but it must be made to work. An enormous omission in it has been highlighted by my noble friend Lady Young of Hornsey: the absence of any emphasis on creative work with children and young people. That absence is significant, and I hope that the Minister will reassure us that although money is obviously being allocated to all the other areas that are mentioned in the plan, it does not indicate a withdrawal of funds or facilities for the arts, and indeed for sport. I was rather depressed, as I think my noble friend was, by play areas being the only reference to this kind of physical activity, which is so enormously important to children. My noble friend Lord Dearing mentioned the absolute necessity of ensuring that local authorities do not divert the funds that they are given to other activities than the ones for which they were meant.
	The noble Baroness, Lady Massey, has asked us to consider the implications of the plan for equality of opportunity, which inevitably calls our attention to education as a necessary first step. There are two groups of children for whom equality of opportunity is absolutely crucial. The first are those who are dyslexic. Here I must declare an interest as the president of the British Dyslexia Association, but I must also congratulate the Government on their proposal to allocate money for improving initial teacher training so that young teachers who are beginning will be much more able to identify children who are either plainly dyslexic or at risk of being so identified later. This is excellent, but there is no point in identifying such children unless they have access to specialist help as they go along.
	The emphasis must be on specialist help, because the usual solution of many schools is to allocate a teaching assistant to those children. Such children may very often be taught almost entirely, or helped along the way, by teaching assistants with no training in the teaching of dyslexic children. These teaching assistants, with the best will in the world, may actually succeed in worsening the condition of the child because the child will not improve without specialist help. That child will find a lack of progress particularly depressing and will lose motivation. It is therefore extremely good news that the Government have now promised a pilot scheme to ensure that every dyslexic child will have access to specialist teachers. I ask the Minister to let us know how soon this pilot may be put into practice and how soon we may hope for a general assumption that children who are dyslexic will have access to its specialist teachers in small groups or one to one. As I said, the news on that front is really very good, and I congratulate the Government on having listened, taken advice and acted on it.
	The second group that I wish to mention is not so fortunate by any means. These are autistic children, especially autistic children who have high intelligence. We are taught that we must distinguish children with learning difficulties from those with mental illness. I have great difficulty with this, because I have no satisfactory definition of what counts as mental illness except that is consists of conditions held to be the province of psychiatrists and other doctors rather than of teachers or educational psychologists. However, this is a strictly circular definition and of no practical value.
	Most of the research that is carried out on autism is the work of academic psychologists who do not especially care about the distinction between mental illness and learning difficulties. All they know, and all we have learnt from them, is that intelligent autistic children cannot be cured, but that their talents need not be wasted if, and only if, they are educated in an environment in which they can learn to feel at home, to feel unthreatened by their contemporaries and to be able to experience a degree of stability in their surroundings so that they can pursue their often remarkable interests. They will remain sufferers from autism or Asperger's all their lives, but many of them will make a huge contribution to society if their education has been properly supervised and properly provided and if they have not suffered too much by being in an inappropriate educational environment.
	For such children, it makes no sense at all for local authorities to insist that they be taught in the mainstream classroom. This is enormously important. I have the vastest postbags, as I am sure many other Members of your Lordships' House have, from parents who are in despair about their children who have been diagnosed as suffering from Asperger's and who simply cannot manage in an ordinary, large, mainstream school. Local authorities are undoubtedly extremely obstinate about such children, because for them it is extremely expensive to send children to small schools that are either non-maintained or even private. For such children, however, small schools are incredibly important. At one time, the Minister spoke of the provision of small schools, at least among mainstream schools. Will he say whether that plan has gone forward and whether small schools or special schools are coming into existence for children who are of high ability but who need the very particular environment that these clever Asperger's children, who are mostly boys, need? I would like to be reassured that although this is not mentioned in the paper, it is in the mind of government.
	The Children's Plan speaks of children who, as they say, "fall behind". But these children do not fall behind; they are often far ahead of their contemporaries in some respects, but they are radically different. I hope the Minister can assure the House that whether they are considered to pose a medical or an intellectual problem, they are noticed as needing special consideration in any plan for children. Only then can they possibly approach equality of opportunity in later life.

Baroness Gale: My Lords, I, too, thank my noble friend Lady Massey for bringing this important debate forward today. I am well aware of her passion for children, as reflected in her opening speech.
	I welcome the Children's Plan for England, which is very good. However, I was somewhat surprised to see in the executive summary that it aims to make England,
	"the best place in the world for our children and young people to grow up".
	On page 15 it says:
	"By 2020 we want England to be the best place in the world to grow up".
	I feel that this is the wrong attitude for the Government of the UK; they have a plan that specifies England as the best place for children to grow up in. I feel that Wales is the best place, but surely we do not have to be nationalistic about this. Working together in government at Westminster, in Wales, Scotland and Northern Ireland, doing our best for all children in the UK, must be the way forward to ensure the best for our children. We should be working together for the good of children, learning from each other's experience and from what has been achieved by the devolved nations. I can speak only about what is happening in Wales, and about where other parts of the UK have followed the Welsh example.
	The first example I give is that of the Children's Commissioner for Wales, who was the first such commissioner in the UK. Now there are children's commissioners for England, Scotland and Northern Ireland. Yesterday I attended the "11 million reception" hosted by my noble friend Lady Massey. There are 11 million children in England, and some of them were at the reception. It was really great to meet and talk to them. I also met the Children's Commissioner for England, Professor Sir Albert Aynsley-Green. He said how much he envies the Children's Commissioner for Wales as he has so much support from the Welsh Assembly Government. The post of the Welsh commissioner differs from that of the English commissioner in that the post is independent. The commissioner reports to the Welsh Assembly, but he is not guided by it. The sentiments expressed by the English commissioner reflected how much he envies the Welsh commissioner. It is a good example of how the countries of the UK can learn from each other for the benefit of all our children.
	Many topics mentioned in the Children's Plan are UK-wide and not exclusive to England, such as the Sure Start children's centres. They have been a great success in Wales, as they have in England. That is another good example of a UK-wide policy working well not just in England but in other parts of the UK.
	Another example is that of tackling child poverty. The Westminster Government have what I would call a passion to raise children out of poverty by 2020, but to achieve that it must be a UK objective with the Westminster Government working with the devolved Administrations to make sure that it happens. The Welsh Assembly Government set out their strategy for tackling child poverty in a document published in 2005 entitled A Fair Future for Our Children. Our First Minister, Rhodri Morgan, said in the introduction that,
	"Giving all children and young people a fair deal is an essential part of creating a better Wales, so the Assembly Government is determined to work closely with its UK partners to eradicate child poverty by 2020".
	I believe that that is the right approach: working together to improve the lives of all children in the UK.
	In February, Brian Gibbons, the Minister for Social Justice and Local Government in the Welsh Assembly, issued a written statement on child poverty. To me, this is a children's plan for Wales, setting out how we can eradicate child poverty and dealing with a range of topics. The Minister said:
	"Tackling child poverty in all its forms is complex and cross-cutting. It requires strong partnership, working with our ... partners—in the UK Government and with our external partners in both the public and the private sectors, as well as within the Welsh Assembly Government itself".
	The Minister's approach recognises that to eradicate child poverty, a concerted effort by all Governments and external partners is needed.
	In the field of education, the Welsh Assembly Government are able to experiment in a way that might not be possible in England, as there are 700,000 children in Wales compared with 11 million in England. The Foundation Phase is a pilot scheme in schools for children in their early years. A Welsh Assembly document on the subject states:
	"The early years of a child's life form a basis for their future development. It is during the early years that we have an opportunity to enhance each child's disposition to learning and to start them on the road to being "lifelong learners". The Foundation Phase is a vital part of the journey, which is based on learning through play, active involvement, and practical activities, and enhances creativity, knowledge, skills and understanding".
	The scheme has proved so successful that it is to be rolled out in all Welsh schools in September. It is estimated that the future benefits of the Foundation Phase will lead to a reduction in disaffection and support those children facing disadvantage and poverty of opportunity. It is another example of what devolution is all about—doing things differently in different parts of the UK but allowing good practice to be copied for the benefit of all. Perhaps the Minister would care to have a look at what has been achieved in Wales. I am sure that young children in England could benefit.
	The health of our children is mentioned in the Children's Plan, so I will mention just one policy relating to children's health. The Welsh Assembly Government recently launched its Autism Spectrum Disorder Strategic Action Plan. Wales is the first country in the world to have established a cross-cutting national strategic plan for ASD, helping an estimated 30,000 people in Wales who are either directly or indirectly affected by autism. Many of those benefiting from the strategy will be children. At its launch, Jane Hutt, the education Minister in Wales, said:
	"Children deserve the best educational start in life and I strongly believe that we must ensure that they are fully equipped to meet the challenge of the future. This is particularly important for children and young people with special educational needs such as Autistic Spectrum Disorder".
	Does the Minister agree that this is an excellent plan, and would he be able to look at it to see what can be learned from it so that children in England with ASD can benefit from something similar?
	The Children's Plan talks about children in primary schools being given time to learn a modern foreign language. In Wales there are excellent policies for children learning two languages, starting as early as 12 months when babies go to playgroups with their mothers and where play is conducted through the medium of the Welsh language. More often than not the children come from English-speaking homes. Later, children can attend school from the age of three up until secondary school and can be taught in the Welsh language.
	If a child is exposed to a second language early in life it is much easier for them to become bilingual, and later it is much easier for them to learn a third and a fourth language. There are so many opportunities in Wales for English-speaking children to learn Welsh. Would the Minister be prepared to consult the education Minister in Wales to look at the tried and tested methods used? They could then be employed to teach foreign languages to English children. As Wales is the only country in the UK to have a bilingual policy, much can be learned from it. This is another example of how we can learn from each other and raise the standards of all our children.
	I could give many other examples of how things are done in Wales which would benefit other areas of the UK, and of course the devolved nations can look to examples of good practice in England. But, as I said at the beginning of my speech, we should not say that one part of the UK—in this case England—would be the best place to grow up. Let all the nations in the UK work together, on devolved and non-devolved matters, to learn from each other and to take best practice from wherever it comes. It is achievable, and, in the end, it is all about doing what is best for all our children.

The Earl of Listowel: My Lords, I, too, warmly welcome the Government's strategy for children. I am grateful to the noble Baroness, Lady Massey of Darwen, for giving us the opportunity to debate the plan and for all the work that she does for children. Most recently, of course, she reminded us of the importance of the Government's education maintenance allowance and the difference that that is making to the engagement of looked-after children.
	I was delighted to see that the strategy makes a commitment on play, with an investment of £225 million over three years. Many years ago I worked as a children's play supervisor and I therefore recognise the importance of play. I particularly welcome the emphasis on the children's workforce and the need to further develop play workers' skills. I remember one boy who always behaved in such a difficult manner that he had to be excluded from a visit we made to Chessington Zoo. The more skilled the workforce, the easier it is to include boys like that one who might benefit most from communal visits to such areas.
	In another case, the child's parent was a milkman. Although I was delighted to take the child ice-skating for the first time, to help him and see him develop, it would have been much better if the father could have been there with his son to see that happen. Again, the more skilled the workforce, the more innovative it can be. Perhaps that milkman would have had time one afternoon to go and enjoy that experience with his son. Those are the sorts of things that I welcome in the proposals.
	The proposal on respite care for families with children who have disabilities is extremely welcome. Having spoken to such families I know, and I think we all recognise, how important and welcome this step is. The respite provided to these families will prevent some children having to enter care. The proposal is most warmly welcome.
	We must not forget the importance of play in school. The Government will eventually oblige 17 year-olds to stay on in school or training. These children will be far more likely to wish to do so if they are enjoying school. The Nuffield Foundation research to which my noble friend referred has found that the most important issue for children attending school is their relationships with other children. Children value play times because they can be with their friends and develop relationships. It is an important factor, but the length of time allowed for play has been slipping. I hope the Minister will use his influence to encourage schools to protect play times during the school day.
	I wish to concentrate on children in care, on a document related to the children's plan entitled Care Matters: Time to Deliver for Children in Care and on the impact on outcomes for children and young people in public care and on leaving care. The Government are absolutely right to wish to raise our aspirations for these children, to be concerned about our failure to ensure that they do better at school and to be frustrated at the welcome but limited improvement in outcomes for looked-after children despite substantially increased investment. I pay tribute to the Ministers who have taken forward this portfolio while I have been a Member of this House: the noble Lords, Lord Hunt of Kings Heath and Lord Filkin, the noble Baroness, Lady Ashton of Upholland, and now the noble Lord, Lord Adonis. It is a difficult brief—these are challenging children—and the Government deserve commendation for wrestling with the problems, sustaining improvements and seeking better outcomes for them.
	I applaud the prioritisation of admissions for looked-after children so that they can enrol in the school best suited to them and not in the least popular school with the only remaining school places. The position of a designated teacher for looked-after children has been placed on a statutory basis. I applaud that as it should help to ensure that this important role is given proper priority and that teachers are equipped to deliver it.
	The new duty on local authorities in the Children and Young Persons Bill to place children locally where that is in the child's best interests should assist in preventing the disruption of a child's education, and the new duty on local authorities to provide a range of appropriate placements should help to ensure that that becomes a reality.
	However, we must not overlook the trauma that most of these children have experienced. To do so would seriously put at risk the chances of success in these children's schooling. Sixty per cent of these children arrive in care as a result of abuse and another 10 per cent because of family breakdown. We are right to have the same aspirations for these children as for our own children, but we must not forget—thank heaven—that our children have not experienced the trauma, loss, rejection, broken relationships, abuse of trust, and often violence that many of these children have experienced. For many of these children a close relationship with an adult is a fearful thing. Paradoxically, they will automatically seek to avoid, undermine or destroy such a relationship as much as a part of them is desirous for it. Feelings arising from their past may well turn them inwards, possibly resulting in depression, self-harm and drug or alcohol abuse; or turn them outwards, possibly resulting in verbal or physical attacks on others or on their physical environment.
	On Monday, 28 April 2008, evidence was given to the Children, Schools and Families Select Committee in the House of Commons. I should like to quote from the uncorrected transcript of the oral evidence of Dr Rita Harris, clinical director of the child and family department at the Tavistock and Portman NHS Foundation Trust, who said:
	"Emotional understanding is central to care, and opportunity alone is not enough. From a mental health point of view, the profound impact of early trauma on children—such as the trauma arising from separation and loss—just cannot be overestimated. We know that people have a built-in propensity to react to new experiences as if they were like previous experiences, and they do not necessarily interpret good intentions in the way in which they were intended. A child may react to very good care by experiencing it as quite damaging and rejecting.
	"The profound effect of trauma and loss on children also profoundly affects adults and those who care for them. Children will often identify with their abusers and be physically and verbally abusive to their carers. They can communicate feelings of inadequacy and worthlessness. Carers often end up wondering why they have lost all the confidence that they had gained with their own child to parent a child. Placements often break down because of carers' feelings of inadequacy and impotence ...
	"The last point that I want to make is that the needs of such children are long term. Short and quick measures do not work with these kids; they have needs that last a lifetime ... parenting is a lifelong exercise. Quite often, looked-after children are the most damaged in society. They need long-term services and have long-term needs. They probably do not need to leave home at the age of 18 and have nowhere to go back to".
	We should take from that that there is a need for long-term commitment and the involvement of sophisticated health support agencies, particularly in the area of mental health. It is therefore no surprise that the Office for National Statistics found that 45 per cent of children in foster care and approximately 68 per cent of children in residential care had a mental disorder. Conduct disorder ranked highly among those disorders and can include fire-setting, theft and attacks on others. The very children who are most in need of a stable relationship are also the most prone to disrupting one. I should emphasise that there is a range of children in this group and certainly not all of them fit this description. However, a significant number of them do.
	Like those who gave evidence to the Select Committee I pay tribute to the work of the specialist nurses who deal specifically with looked-after children, particularly Miss Kathy Dunnett, whom I have known for some time. She was for seven years a specialist nurse in Hertfordshire and has edited a helpful book entitled Health of Looked After Children and Young People, which I commend to the House.
	The Government recognise these children's need for stability. It is most welcome that they are piloting programmes that allow looked-after children to continue in care to the age of 21 if they so wish. It was encouraging to hear the Minister, Kevin Brennan, at a recent meeting and to learn that he is increasingly of the opinion that all children and young people in foster care should have the choice of staying to the age of 21. That is most welcome. Stable relationships of this kind are exactly what is required to enable a young person to recover from earlier trauma and re-engage with the world, to study, to make loving relationships, and to have the possibility of not repeating the cycle of abuse and the recurrence of that abuse in their relationships with their own children.
	However, continuing patchy access to child and adolescent mental health services jeopardises the outcomes that the Minister wishes to deliver. Mental health services are overstretched and CAMHS is a small fish in a large pond as far as mental health is concerned. Looked-after children are a small part of CAMHS' concerns; they can be at the bottom of the pecking order. Looked-after children have been prioritised in schools by local authorities and this is very welcome. Similar prioritisation needs to be given to them in health. The Government propose to introduce statutory guidance for health authorities. I regret that this is unlikely to be sufficient. A stronger duty is necessary and more effective means of monitoring its implementation need to be made available. Does the Minister recognise these concerns? There need to be more specialised child and adolescent mental health service teams focusing on looked-after children and there needs to be research into their efficacy. Specialist CAMHS are very expensive and need to be evidenced if they are to survive in the long term. Will the Minister consider this particular area?
	In the Children and Young Persons Bill my noble friend Lady Meacher has emphasised the need of looked-after children, when they enter care, for improved assessments which look far more effectively at their psychological and mental health needs. I hope the Minister will think further about what she has proposed. On Tuesday I was introduced to four people by the Children's Bereavement Network.
	I think I should stop now—but I look forward to the Minister's response.

Lord Ramsbotham: My Lords, I join those who have congratulated the noble Baroness, Lady Massey, on obtaining this important debate. I also pay tribute to her indefatigable chairmanship of the All-Party Group on Children. She arranges for a remarkable series of subjects to be discussed. They are all relevant and pertinent, and all meetings are chaired with a splendid lightness, as well as seriousness, which is a model of its kind. Like my noble friend Lord Listowel, I pay tribute to the Minister, not least for the courteous and speedy way that he has commented on and responded to all the various points made during proceedings on the recent Children and Young Persons Bill. It is a model of how it might happen and I wish that some of the Minister's colleagues would learn from him. That remark is, perhaps, not appropriate.
	The noble Baroness said in her speech that she was two and three-quarters in favour of the plan. I join her in that. There are tremendous things in the plan as far as intentions are concerned. Like the noble Baroness, it is the implementation that concerns me most. Obviously, the group of children who concern me most are those who end up in the hands of the criminal justice system, not least those in custody. I draw attention to four particular aspects, all of which appear in the plan, and all of which are currently being picked up by good practice somewhere in the system, but none of which are being turned into common practice everywhere. If there is a theme in the implementation of this plan, I hope that it is one of picking up good practice—because all over the place there is good practice by the devoted practitioners to whom attention has already been drawn—and turning it into common practice, from which all can benefit. The "all" is the children of this country and there is no more important group to which we owe a duty of care.
	I will refer to the four aspects by the paragraphs in the plan and speak to each in the order in which they appear, not the order of priority. I pick up the first in paragraph 3.61, which says:
	"The pilot is aimed at improving ongoing assessment and tracking by teachers, with an offer of one-to-one tuition for pupils".
	It is remarkable, going into young offender institutions and looking at the education achievement or non-achievement of these people, that many of them have dropped out of school and, when you talk to them, are unsure whether the reason was boredom before drugs, or drugs before boredom. The word "boredom" worries me because it suggests that the teachers are not engaging them. You do not engage them by repeating the blackboard-type instruction from which they have walked away.
	There is, in Feltham, a remarkable piece of work called the Volunteer Supported Education Scheme, which began in 1992 and has been praised consistently by both prison and education inspectors ever since. The volunteers go in, one-to-one, to these young offenders and achieve remarkable results. For the life of me, I cannot understand why that has not been picked up in every young offender institution in the country. It works, it is cheap and it involves the local community in looking after their own. I have written to Ministers about this; I have had one reply from the noble Lord, Lord Adonis, but not from any of the others. If there is to be a serious attempt by the new consortium of justice and education working together, this seems to be just the sort of project that they ought to be picking up and running with.
	Secondly, I come to the problem of communication skills. The failure and inability to communicate is one of the scourges of the 21st century. Children simply cannot do it. In this House I have already drawn attention to this problem, and to a trial funded by the Helen Hamlyn Trust, where speech and language therapists were put into young offender establishments, and which had a remarkable effect. The assessments produced by those speech and language therapists highlighted problems that could be picked up by healthcare, education and behavioural discipline staff. Indeed, one of the hard-bitten disciplinary staff told me that they had been damaging young children in there until they were told that there was another way by the speech and language therapist. The trial finished in 2005, since when there have been three years of inertia. I am glad that John Bercow MP is now conducting an inquiry, and that the work of that trial is being included. I hope he will come out with confirmation of the fact that you find, in young offender establishments, children aged 15 and upwards who are unable to communicate with each other, and tend to conduct relationships with the fist rather than the mouth because they know no other way. Had those children been assessed before they went to primary school, their communication difficulties could have been alerted and resolved, enabling them to communicate with their teachers, and possibly then avoiding their ultimately opting out of school and becoming the truants that cause the problem.
	Thirdly, I draw attention to paragraph 3.133, which talks about the achievements of gifted and talented learners. Unsurprisingly, in many young offender establishments you find some very gifted young people who have turned to crime out of frustration because nobody has picked up their talents and run with them. For the past 10 years, Gabbitas has been running a programme called "Tomorrow's Achievers". The idea is to identify the talented young and give them master classes that will enable them to maximise their talents. That was put to the Prison Service in 1997, since when absolutely nothing has happened. We are not talking about huge numbers, but if the Prison Service is not prepared to look at the talented and do something for them, that says to me that it is not looking at all the young people in its hands and all their needs and possibilities. This would cost the Government nothing, and it is an example of good practice that needs to be picked up.
	Finally, I come to paragraph 6.68, which says:
	"The new cross-government responsibilities for youth justice present an opportunity to look at how we might strengthen the approach we are taking to offending".
	I agree. One of the biggest bars to any form of progress with young people at the moment is the institutionalisation conducted in the young offender establishments up and down the country that do not do the job as effectively as possible. One of the reasons for that is that far too many people are being moved around from place to place, from instructor to instructor, from mentor to mentor, from someone who could be a guide to them to another guide.
	There is an opportunity in the pipeline to change all that, by picking up the ideas that have come from an organisation called East Potential in the East End of London, which suggests that a ring could be drawn around an area with about a one-hour radius from the centre, and all children who become involved in the criminal justice system within that radius should all be based on an establishment that would include within its perimeter a foyer, a place for homeless youngsters; a high-level security centre for the small few; and the facilities—the classrooms, the drug treatment centres, the workshops and other places for activity—related to that local area. The ownership of what went on with people in an area would therefore be delegated to the people in that area, which would provide a chance for consistency and continuity so that relationships between the damaged young, the young who are turning down the crime road, could be consistently looked after. They would get to know the people and could build up a relationship that might be the vital thing that kept them on the right road.
	That is a splendid development because it has come up from below, from the housing associations in the East End. It has been supported by industries that can see the opportunity for training people to be employed by them. It has come from those involved in education and in drug treatment, who can see that there is continuity in the plan. It has come from social workers, who feel that it is another way of getting over the problems of inconsistency of the treatment of people in care. Here is an opportunity for the new consortium to pick up and pilot something that is designed to eliminate the problems that are created by the current situation.
	As I said, I am grateful to the noble Baroness, Lady Massey, for introducing this debate, because it is an opportunity to put before your Lordships the marvellous work behind the things I have talked about, with the hope that they will be picked up and run with.

Baroness Howe of Idlicote: My Lords, it is a great pleasure—indeed, almost an honour these days—to follow my noble friend Lord Ramsbotham, who is always inspiring in what he has to say on this subject. I add my thanks to the noble Baroness, Lady Massey of Darwen, both for giving us the opportunity to discuss the Children's Plan and for her brilliant chairmanship of the All-Party Group on Children.
	The report outlines a considerable number of changes, some currently subject to legislation but all of which will profoundly affect the childhood of the UK's rising generation of young children. Like many noble Lords who have spoken, I welcome the report but share their concerns about timing, resources and areas that have not been mentioned, such as the arts—my noble friend Lady Young made an important speech on that—and, perhaps most vital of all, the need to know that the voices of children themselves have been heard on all the proposals in the plan.
	The Motion of the noble Baroness, Lady Massey, however, draws our particular attention to the plan's implication for our most disadvantaged young people and how the measures it contains are specifically designed to increase their equality of opportunity. In that respect the Children and Young Persons Bill, which is currently being scrutinised in another place, is particularly to be welcomed, dealing as it does with the crippling disadvantage endured for so long by our so-called "looked-after children". Like other noble Lords, I shall be commenting on that remarkable Bill later in my speech, but I shall start with one or two more general comments.
	The emphasis on extra help for the early years is to be welcomed as an essential foundation for the future. The extra funding entitlement to nursery care for all three and four year-olds from 12 to 15 hours is welcome. However, I hope that every effort will be made to include the voluntary and independent sectors among those who are providing the care. We should never forget the way the voluntary sector, by setting up the Pre-school Playgroups Association and other nursery facilities, provided that care over decades when Governments and local authorities did practically nothing. I also refer back to the Adventure Playground Association because that, again, was the start of things that now, thankfully, are seen as important and are being recreated. Especially welcome, though, is the plan for a free nursery place for 20,000 two year-olds from the most disadvantaged communities.
	I saw a case study example on page 21, where Manchester City Council encourages parents who have attended parenting support sessions to mentor other more vulnerable parents. That reminds me of the care committee work in London that members of my generation did in the 1950s, where voluntary workers were mentoring disadvantaged families and were attached to specific schools.
	The extra support for disabled children and their parents and carers, which your Lordships have already mentioned, particularly the point about respite care, which all local authorities are now to provide, is quite excellent. It was heartening earlier this week to hear the noble Lord, Lord Adonis, to whom I also pay huge tribute for his deep commitment to his brief, praising my noble friend Lord Rix for his persistence in calling for action here, which has at last produced results.
	I turn to the school curriculum. I welcome the decision to review the primary curriculum to find more time for teaching and embedding the basics, such as English and maths—especially reading. That is crucial, as my noble friend Lord Dearing has said, not least in today's world of ghastly form-filling. We all face that, but the most disadvantaged are at the greatest disadvantage in filling out these forms.
	A second hooray for my noble friend Lord Dearing: a modern foreign language is now to be taught in all primary schools. I find it considerably surprising that it is only now that we are beginning to hear complaints from industry that it is losing contracts because our young people are not sufficiently well trained in foreign languages. Well, good; let us at last get together and get going on this subject.
	There is so much I could say about what is, in many ways, an inspiring report but I want to spend the rest of my time on three specific issues: extra support and resources for young people in custody; the new diplomas and raising the school-leaving age to 18; and the role of school governors.
	Starting with school governors—I declare an interest as president of the National Governors' Association—does the Minister see their responsibilities as a management role, or to ensure that there are members of the local community involved in guiding the school and its pupils' development? Governing bodies clearly already have heavy responsibilities, and with, for example, extra preference rightly being given to the choice of the most suitable schools for "looked-after" children and others with special needs, governors are likely to need extra expertise. The report says that extra training for school governors is envisaged, which is good; yet, against that background, what is the rationale—covered in the briefest of references on page 99 of the Children's Plan—for wishing to reduce the size of each governing body? Indeed, what is the Government's view of the ideal size of a governing body? I look forward very much to hearing what the Minister will say on that.
	Secondly, on young people in custody, a greater emphasis on supporting disadvantaged and chaotic families at the earliest possible stage of their children's lives should, one hopes, reduce over time the number of young people ending up in prison—not least if we go for a Corston approach, so that families are not necessarily broken up when offending mothers end up in custody. We need constantly to remind ourselves that over half of all those imprisoned had been in local authority care: almost half have literacy and numeracy levels below that of an 11-year old, while 40 per cent of boys and 67 per cent of girls—a horrendous figure—have serious mental health problems.
	However, once within the penal system, the first concern must surely be to concentrate on equipping the young person for a non-criminal career when they leave it. Clearly, the appalling overcrowding that currently exists in all prisons causes huge difficulties for prison officers and inmates alike. I know that a number of pilots are now testing some things that can be done, particularly with regard to restorative justice. Preferably, and crucially, those could be organised within the offender's local community.
	I also hope that the Minister will be able to indicate how the Government can help to ensure that prison apprenticeships, and other basic forms of education in such schemes, can become a priority in all prison settings. Moreover, those schemes should start early; the idea of beginning your apprenticeship toward the end of your time in prison seems completely to waste that important period of being inside. Can the Government confirm that they plan a determined blitz on that age group of young offenders, so that, on leaving prison, they are equipped with a place to live, a job or training, and, above all, someone equipped to act as a friend, adviser or mentor?
	Lastly, I turn to Government plans to raise the school-leaving age to 18 by 2015. As the Secretary of State, the right honourable Edward Balls has said, that is probably the biggest educational reform of the past 50 years. There will obviously be other occasions to debate more fully the advantages for our rising generation; I can see that those could be considerable. Above all, if we are to compete globally, UK citizens will need both academic and practical skills, and to have those updated regularly.
	Returning to the disadvantaged young, with whom we are concerned today, is the Minister sure that they will find being required to stay an extra two years within the education system a welcome move? They will have already failed—and been failed—within that system, and many will have truancy records. Sadly, only yesterday I saw that those have risen again quite sharply, despite recent laws to penalise parents if children miss school. I have always had doubts about that government policy. What worries me is that the Government may be considering penalties rather than carrots to attract the young people who will need particularly careful handling if they are to gain from this move rather than be further alienated. I hope the Minister will be able to reassure your Lordships on that point and perhaps expand on more flexible ways of delivering education and training to those young people.

Baroness Butler-Sloss: My Lords, I, too, thank the noble Baroness, Lady Massey, for proposing this debate and for inviting me to speak. I also congratulate the Government on the Children's Plan and the excellent initiatives that have come forward in it and in relation to children in care. Most of what I would like to say has already been said, but I will make a few points none the less.
	I share the concern voiced by many noble Lords that the real issue is the implementation of the admirable suggestions of this Government. That will be a difficult issue, requiring, I suspect, considerable additional resources over and above those already committed—for which the Government ought also to be congratulated. I share the view of the noble Lord, Lord Dearing, about the urgency of what needs to be done in some areas, because education—which has been referred to again and again in today's debate—is clearly the key to redressing disadvantage and inequality.
	I will refer to a number of groups, although I appreciate that most of them have already been referred to. First, obviously, are children in care or looked-after children. Much has already been said about that group, so I shall refer to a number of others whom the Government ought to have within their sights in dealing with what is needed to help children who may suffer from disadvantage and inequality in the future. Those children will be living at home; one group—I agree here with the noble Baroness, Lady Warnock—is that of children with learning difficulties, especially dyslexia.
	I happen to have personal experience of an intelligent little girl at an excellent primary school that is inadequate for helping with her dyslexia. She has inadequate specialist care, and the educational psychologist is urging the family to remove her to another school. Yet she, being extremely happy where she is, says that she will not move from that very good primary school. I am delighted with the initiative suggested for helping children, because all too many out there are not getting that help at primary school, so that by the time they get the rather better help provided in secondary education it may well be too late to catch up effectively.
	Children with mental health problems, as the noble Earl, Lord Listowel, has pointed out, have real problems with CAMHS. I am delighted to see the initiative proposed between the government department taking part in this debate and the Department of Health, but CAMHS is not performing as well as it should for there is no uniformity across the country. It is a considerable challenge to those two government departments to get sufficient help within a sufficiently quick time. As I have said in Committee on the Children and Young Persons Bill, if you do not get help to a child within a relatively short time, it is not good enough to give it 18 months later. Therefore, I am delighted by the suggestion about working with CAMHS but I hope the Government appreciate the size of the problem that they have to meet.
	There are other children with problems at home: children who suffer from abuse, who have already been referred to; children who suffer from domestic violence; children who suffer from the mental health problems of parents; children who suffer from neglect; and children whose parents are separated or where a parent has died. The loss of a parent on separation usually involves the loss of a father. It is very important that we appreciate the importance of fathers. I think that the public under-appreciate this, as indeed, many of us do. The Government under-appreciate the importance of fathers and have been a little coy—particularly as regards the Child Maintenance and Other Payments Bill—about recognising fathers' role in paying the money rather than recognising also the important part they play in the lives of their children. Fathers have a real contribution to make to the lives of their children and the Government should push this message through as part of the general propositions that go forward. That is not, of course, to say that one-parent families do not do extremely well, but where fathers are around, they should be made, and should want to be made, part of the family group. Their absence, and the problems of separation, are known—particularly to child psychiatrists—to be another reason for children doing badly at school. Therefore, I am very pleased to hear about the proposals for tutor groups.
	I agree with the noble Lord, Lord Dearing, that tutor groups are extraordinarily useful. I happen to be a governor of an independent school that has a tutor group system comprising children of different ages. I asked whether it was a good idea to have children of different ages and was told that it was a really supportive way in which the older boys could help the younger boys. I think that they meet weekly, as the noble Lord, Lord Dearing, suggested.
	We need to understand that there are troubled children out there who do not come from obviously disadvantaged families. However, their problems at home show themselves at school in all sorts of ways, including inattention or bad behaviour. I support the idea of a tutor being there to identify the problem and see whether anything can be done to help the family. Part of the concept behind this excellent Children's Plan is to give support to the family. This is a very practical way in which it can be given to enable the child to put the problems at home to one side and to get on with his schooling, without which that child will undoubtedly be disadvantaged.
	One very obvious group of disadvantaged children are those excluded from school who need more education rather than less. As I understand it, many excluded children get one, two or three hours a week of actual teaching. How on earth will they be reintegrated into the mainstream? I have personal experience of an American boy who was excluded from school aged 14 or 15 and went to a school in Virginia that is designed to deal with excluded children. A year later he was reintegrated into his mainstream school and is now doing well. This is an extremely good idea and far preferable to individual tuition, which is inevitably inadequate for excluded children. If we do not do something about excluded children, they will be fertile breeding grounds for crime. If they cannot read, write, spell or add, what else do they do? It is obvious that they will become criminals for the rest of their working lives to the huge detriment of the public. As the noble Lord, Lord Ramsbotham, pointed out, children who offend clearly need education. Indeed, as the noble Baroness, Lady Howe, said, if they can undertake apprenticeships, they should get them early. It is obvious that not only do the public need to be protected when children offend but that children need to be prevented from reoffending. The key to that, as to so much else, is education. To move them from place to place or to change their mentor or education means disruption, which will provide them with a limited ability to work when they are released and will almost inevitably lead to their reoffending.
	The play proposals are excellent but are schools still selling playing fields? I hope not because that comprises a very small but important initiative that the Government could take to ensure that local authorities are not disposing of land that would be much better used for children.
	This is a splendid plan but we face a huge task. I hope that the Government will recognise the large number of different groups of children who need help now, not by 2020.

Baroness Walmsley: My Lords, I, too, am grateful to the noble Baroness, Lady Massey of Darwen. When the Children's Plan was first published, David Laws MP said it was a mouse of a plan for a mountain of a problem and that it was nothing more than a hotchpotch of reviews, recycled policies and gimmicks with the unifying theme of a belief in top-down big government solutions. While I might agree with that analysis I will try to be a little more charitable. It is not unreasonable to pull a lot of existing initiatives together in one document and I never expected it all to be new. So I give a general welcome to the plan and the concentration on children's well-being. Many things have improved for children in the past 11 years but some, often from disadvantaged backgrounds, are still under-achieving and, indeed, struggling to cope with life at all.
	The plan is ambitious. The first chapter alone covers parenting support, early years, play, poverty and housing—an enormous agenda. I particularly welcome the money for two parenting advisers in each local authority and to expand school-based parent support advisers. However, two is not a very large number and it seems to me that they will land up working mainly with the chaotic families. Obviously, you would expect them to prioritise the worst cases but I cannot help thinking the Government have missed a trick—they are presiding over a reduction in health visitors who comprise a very well regarded, universal service—to give all families help with parenting from a source they can trust. Many behavioural problems in childhood and right up to adulthood, including criminal behaviour, can be attributed to stress at crucial stages in infancy and lack of the right sort of parental behaviour. Mostly this is due to lack of understanding of the effects of parental behaviour rather than intentional neglect. Most of us are not child development experts so we need to be advised about the effects of what we do as parents. So why are we not insisting that all teenagers in schools learn about child development and good parenting? We insist that young people learn all sorts of other things that will be less useful to them in their future lives. There is nothing more important than learning how not to screw up the next generation. It is almost too late when existing parents consult parenting advisers about their difficult children, and it is certainly much harder to deal with at that stage.
	Many children do not have a garden in which to let off steam, but we hear that there will be more investment in playgrounds, some of them supervised by trained playworkers. I agree with the noble Lord, Lord Dearing, that this is a very good thing. Children need to have fun but it must be done in co-operation with local communities and the young people in them because unless they have ownership of these new facilities, they will be trashed in no time, and that would be a great pity.
	The plan includes the Government's ambition to eradicate child poverty by 2020 and tackle poor housing. The Government are doing quite a lot to help poor working families now that they are committed to compensating them for the loss of the 10p tax band; however, they chickened out, when we discussed the Work and Families Bill last year, of allowing parents of children of all ages to request flexible working and have their requests seriously considered. That was a great pity. Most parents would prefer to work and be able to share looking after their children rather than pay someone else, but their jobs do not allow them to do it. We need the Government to think again on this matter.
	The second chapter covers all safeguarding issues. It is all good rhetoric but there is a big black hole in it. The place where most children suffer harm is in their own homes. The Government are still refusing to address the matter of violence against children in their own homes. They have done a lot about domestic violence, which is what they call violence against an adult partner, but they seem to forget that a man who hits his wife often also hits his children. Indeed, a man who hits his dog very often hits his children too but nobody thinks to ask whether the children of a man prosecuted for cruelty to his animals are also ill treated. We ignore this issue at our peril. Not only is it a matter of equal human rights, where children have the same protection under the law as their mothers, but the WAVE foundation has reported that violence against children has long-term developmental and emotional effects which prevent them reaching their proper potential. Stress bathes the child's brain with the stress hormone cortisol, which stifles correct development. The science of infant brain development should underpin any government policy about children, but it does not. A children's plan which has the ambition for every child to fulfil his or her potential is the poorer without action on this matter. As the noble Earl, Lord Listowel, indicated, a programme that does not contain a massive increase in child and young person mental health services is not fit for purpose.
	Chapter 3 talks about a new relationship between parents and schools. It claims that parents' councils will ensure that parents' voices are heard within the school, and yet these councils have no teeth. Without real power, parents can do nothing. Intensive coaching for those who need it, more attention to training for teachers in SEN and a new look at testing are all welcome items in this part of the plan. Sir Jim Rose is to review the primary curriculum but I hope that the Government's resulting policy will not be as prescriptive as their reaction to the last Rose review. I speak, of course, about the Whitehall edict that professional teachers are told to teach synthetic phonics, whether they consider the child has sufficiently well developed verbal skills or not. The concentration on literacy seems to have skipped a vital stage—that of oracy. The three Rs are all very well, but talking and listening must come first. Without good verbal skills, the child will not have a sound foundation for reading. I agree with all that the noble Lord, Lord Ramsbotham, said about this. I also hope that the Government will pay attention to the Cambridge Primary Review which is nearing its end and which has already had a positive effect on policy through its interim reports.
	On the matter of testing, I have a story to tell the Minister. I was talking last night to a completely non-political parent who told me her 14 year-old goes to the highest performing comprehensive in her county. But she said, "They do not educate the whole child. They just tick boxes and push them out like chickens on a production line". Those were her very words. Is that what we want for our children? Many schools know better in their heart of hearts. You only have to walk into a school, as I do almost every week, to see what they are proud of. This echoes what the noble Baronesses, Lady Young of Hornsey and Lady Warnock, said about the arts. Displayed on their walls are not lists of their GCSE results but pictures of their school plays, concerts, sports achievements, artwork, foreign trips and environmental projects—the things that make well rounded, happy children. They know that these are the things parents really want so they show them off, and they know that happy children learn effectively.
	That brings me to chapter 4 which is about raising educational standards and closing the gap in attainment for disadvantaged children. Some of the most disadvantaged children are refugee and trafficked children. It is vital that these children—the only ones for whom responsibility is placed outside the DCSF in the Home Office—are not left behind. The amendment tabled by the noble Baroness, Lady Morris, to the Children and Young Persons Bill, now gone to another place, will make a difference and I hope the Government are not planning to reverse the decision of your Lordships' House on this matter.
	As part of the consultation on the safeguarding code of practice, the Government are reviewing the UK's immigration reservation to the UN Convention on the Rights of the Child. I strongly support the removal of this reservation which creates a two-tier system which can result in serious confusion about the rights of refugee children. That brings me to the absence of the convention from the Children's Plan. The Children's Society, in its briefing to us for this debate, gave one of the best descriptions I have read about what the convention is about. This is what it said:
	"The UNCRC is the best and most comprehensive encapsulation of the vision we have for all children. It describes a culture in which it is unequivocally clear that each young human's unique existence is of no lesser worth than that of any fully grown human, and that they are therefore equally entitled to be treated at all times with dignity, humanity and mutual respect. It describes a society in which each child is offered support, protection and their own voice as an individual within a recognised nexus of responsibilities and close relationships with family, community and the State".
	It went on to say that it believes that delivery of the Children's Plan should be overtly premised on the convention, and I heartily agree.
	This Government have recognised the importance of the early years and I salute them for that. Among the measures on improving the teaching work force, I particularly welcome funding for supply cover so that early years workers can go off and do some training. I had the pleasure recently of presenting an early years professional certificate to the leader of a playgroup in the village where I used to live. Her tale of how she had to struggle to get the time to do the work was a credit to her dedication and that of the rest of her team who piled in and helped her. Funding is really needed on the ground.
	The Government are again turning their attention to what happens to children who are excluded from school and are about to pilot new forms of provision. I would have preferred more attention to their special needs within their school. We all know that an inflated proportion of children with special needs are excluded. Their bad behaviour often reflects the fact that their needs are not being met.
	Chapter 6 includes youth alcohol and drug action plans but there is nothing about standing up to the supermarkets about selling cheap alcohol to kids. Why not? There will be a review of best practice in sex and relationship teaching in schools. When will the Government make it compulsory? I agree with the noble Baroness, Lady Massey, about that.
	Right at the end of the plan there is the plum—a commitment to a youth crime action plan. I am pleased to say it talks about restorative justice, prevention and education and offers a serious look at what happens when children leave custody. There is recognition that further action is needed to ensure the safety of children and young people in the youth justice system. However, the best way to ensure children's safety in custody is to keep them out of it. During the recent passage of the Criminal Justice and Immigration Bill, much discussion took place about the introduction of a distinct children's custody threshold. Such a threshold would have to be met before any child was sentenced to custody. Will the Government seriously consider that proposal within the process of developing the youth crime action plan?
	I will end this half critical analysis with a resounding hooray. My overall marks are: nine out of 10 for rhetoric, eight out of 10 for ambition but still only six out of 10 for content.

Baroness Morris of Bolton: My Lords, when the Minister introduced the 10-year Children's Plan in a Statement last December, I said that many of the issues were massive subjects in their own right and impossible to cover in such a short time, but that I saw rich topics for future debates. I am not surprised that one of the great champions of children in your Lordships' House, the noble Baroness, Lady Massey of Darwen, has chosen this important theme for her debate. I, too, am most grateful to her, although yet again it is possible in the time given only to scratch the surface of what is, by any standards, a big and ambitious plan. Its breadth has been demonstrated by the wealth of speeches today. The right reverend Prelate the Bishop of Norwich told us of the importance of play and African drumming in Norfolk, and I could not agree more with the noble Baroness, Lady Young of Hornsey, that refugee children seem to be seen as somehow not our children. As the noble Baroness, Lady Walmsley, said, we won an important vote in the Children and Young Persons Bill on this very issue, and I, too, hope that the Government will not seek to overturn it in the Commons.
	The noble Baroness, Lady Warnock, spoke of the importance of specialist help for dyslexic children. As someone who is dyslexic, I support her view, and I say to the noble Lord, Lord Dearing, that you should try filling in a government form if you are dyslexic. I assure the noble Baroness, Lady Gale, that, as someone who has been going to north Wales for her holidays since childhood, I wholeheartedly agree that Wales is a great place to grow up. As always the noble Earl, Lord Listowel, spoke about children in care with great authority and compassion, as did the noble Lord, Lord Ramsbotham, speaking on children in the youth justice system, with his important emphasis on communication. The noble Baroness, Lady Howe of Idlicote, was once again the voice of children having a voice on these proposals. The importance of fathers in the upbringing of their children was highlighted by the noble and learned Baroness, Lady Butler-Sloss, and I sincerely echo her view.
	Who could disagree with the subtitle of the plan, Building brighter futures? As my honourable friend Michael Gove said:
	"Improving children's lives is crucial, as is closing the gap between rich and poor".
	Many of the things included in the plan are themes that we support and have studied in our childhood review. I hope that will reassure the noble Lord, Lord Dearing, in his call for continuity. Where we have issues with the plan is not in its ambition for our children, but in its somewhat grand and, as the right reverend Prelate said, sometimes state-ist nature; with the danger that initiative overload and a lack of focus may harm the very causes that the Government are genuinely trying to address.
	This concern was echoed by the Children, Schools and Families Select Committee when it published its report on the impact of the Children's Plan. The chairman of the Committee, Barry Sheerman MP, urged the Government to be clear about what they hoped to achieve. The report also criticised the lack of a timetable and the lack of prioritisation. It stated that those are,
	"weaknesses which need to be rectified, otherwise the Children's Plan runs the risk of being simply a wish list rather than the mission for the Department of which the Secretary of State spoke".
	Or, as my honourable friend Michael Gove said:
	"How can the Secretary of State credibly say that he is clearing away the clutter and empowering professionals when he is sticking his fingers into everything and generating gloop on an industrial scale?".
	In the interests of not adding to the gloop, I intend to focus the rest of my remarks on three areas.
	The right to a childhood is a fundamental right of children. To be able to play, to explore, to spend precious time with friends in a safe environment are vital ingredients in giving children back their childhoods. The £225 million to be allocated over the next three years to build or upgrade more than 3,500 playgrounds and the 30 adventure playgrounds designed for the eight to 13 age-group in deprived communities are welcome initiatives. But unless those spaces are safe and we reclaim many of our existing playgrounds from the gangs that have taken them over—the Home Office suggests that 43 per cent of gangs meet in children's playgrounds—parents will not have the confidence to let their children use and enjoy those essential spaces. The children who will suffer most are those from disadvantaged backgrounds, who will spend more time indoors watching television. Research by the National Consumer Council, entitled Watching, Wanting and Wellbeing, shows that on Sunday afternoons 32 per cent of children from the poorest families in the UK are watching television; whereas it is only 7 per cent in the more affluent families.
	As we found in our childhood review, if children do not have space to play with others, their chances of social mobility may be reduced. Physical mobility affects social mobility. We need to reclaim our parks and our streets. I was delighted when my honourable friend Boris Johnson, the Mayor of London—I love saying that, Boris Johnson, the Mayor of London—immediately appointed Ray Lewis, who has done such wonderful work with young people in London, to be one of his deputy mayors, to address these critical issues. Part of reclaiming the spaces that we already have and making sure that the new provisions are well utilised is an adult presence. I am sure that we all remember the park ranger, who more often than not lived on the site. It may not be possible to return to those days, but some exciting initiatives are being carried out by the voluntary sector.
	In Balsall Heath in Birmingham, there has been an impressive social revival, led by Dr Dick Atkinson, where every street now has a street steward. The charity Play Rangers goes in and livens up neglected playgrounds and sets up games and activities that the kids want to take part in, because playgrounds can and should be exciting and challenging. The result of that work is that parents and children have confidence, come back to those areas and they thrive. There is of course an added bonus to all these schemes, and that is important intergenerational contact.
	However, the best way to ensure that we reduce inequalities among children is to raise the standards in our schools. That is one of the aspirations of the plan; but we must not forget that this 10-year plan comes only three and a half years after the Five Year Strategy for Children and Learners. That strategy also included promises of reforms that would raise standards by 2008, including reaching and sustaining literacy and numeracy targets of 85 per cent of children reaching the expected level at age 11. The reality is that the target was missed and dropped in favour of an easier target of 78 per cent of pupils by 2011. It was also anticipated in the five-year strategy that school absence would be reduced by 8 per cent compared with 2003. A reality check shows that truancy is at its highest level for 10 years.
	I fully recognise that the Minister is dedicated and works tirelessly to raise standards in our schools. Where under the academies programme a school has been allowed the freedoms to embed an ethos and culture, there have been remarkable transformations. Those are schools operating in deprived areas and taking their fair share of challenging pupils. We hope that the academy programme will be rolled out as widely as possible and that its necessary freedoms will not be further eroded.
	We share the concern of Conor Ryan, who was David Blunkett's adviser, that there are real tensions in the Children's Plan. He said:
	"Although the plan has some new ideas ... it is more about trying to marry two competing policy approaches. The tension inherent in this process might make it harder to raise school standards and eliminate child poverty than ministers imagine".
	It is important that we do not lose the focus on standards, which means tried and tested methods to ensure a proper grasp of the core subjects, with key stage testing and league tables as vital tools to measure those standards. It also means the teaching of phonics and setting by ability to give all children the best chance in an ordered and disciplined environment, where learning can take place uninterrupted by the disruptive minority and where, as the noble Baroness, Lady Massey of Darwen, said, they can enjoy learning. It also requires the urgency that the noble Lord, Lord Dearing, and the noble and learned Baroness, Lady Butler-Sloss, spoke about so passionately. Our children need to be properly equipped for the future, so that they can take their place in society as well-rounded individuals.
	The most important ingredient in ensuring that our children have a brighter future is parents. We welcome the somewhat belated recognition that,
	"government does not bring up children—parents do".
	We really should not have to state the obvious. All that we do should be about supporting parents. As the noble Baroness, Lady Howells of St Davids, rightly asked, how will that be achieved? As I said when we first discussed the plan, I worry that the Government have sent so many confusing messages to parents that parents are either scared of doing things in case they do the wrong thing, or they feel that they need not bother because the state is doing it all. What we should be doing is empowering parents to be the best they can be and not trying to stand in their shoes.
	Closing the opportunity gap is at the heart of the task that David Cameron has set the next Conservative Government. We have already announced proposals on health visitors—which will please the noble Baroness, Lady Walmsley—and childcare, which extend to the poorest the support that is currently enjoyed only by the more affluent. Speaking at the launch of our child review, my right honourable friend David Cameron said,
	"we can create a strong and confident society in which children live, play and grow happily within the boundaries of the common good".
	I am sure that we can all agree with that sentiment.

Lord Adonis: My Lords, the House is indebted to the noble Baroness, Lady Massey, for introducing this excellent debate on the Children's Plan. Let me say at once that we have achieved an average eight out of 10 from the noble Baroness, Lady Walmsley, who is perhaps my most relentless taskmaster in this House, which demonstrates that the Children's Plan must indeed be a paragon among government publications. I take that to be high commendation indeed.
	Earlier this week my noble friend Lady Massey with her customary deftness of touch chaired a large meeting of the All-Party Parliamentary Group on Children. The noble Earl, Lord Listowel, and the noble Baroness, Lady Howe, were also present and spoke, as did I. The all-party meeting was focused particularly on disabled children with many organisations present representing children with disabilities and learning difficulties, as well as parents with disabled children. The cause of those children was mentioned again today by the noble Baroness, Lady Howe, and as Minister for Disabled Children I begin by saying a few words about this important group of children, whose interests are advanced further as a key part of the Children's Plan.
	I was glad to be able to tell the all-party meeting of the radical improvements that we are making to services for disabled children and their families, particularly the new ring-fenced three-year funding of approaching £400 million to transform local short-break and respite services for them. I recently launched the first local authority pathfinders for this enhanced short-break service in the London Borough of Sutton, alongside the Liberal Democrat leader of that borough. I heard at first hand from the parents and young people the difference that this will make to their lives. The all-party meeting was also glad to hear about the amendment that we made in this House to the Children and Young Persons Bill, with all-party and Cross-Bench support, to empower the Government to set minimum standards for short-break services in all local authorities, so that the improvements we are making under the Children's Plan are sustained beyond 2011 and there is not a postcode lottery of provision for disabled children and their families, leaving some disadvantaged or unsure of their entitlements.
	The noble Baroness, Lady Warnock, and the noble and learned Baroness, Lady Butler-Sloss, raised the important issues of dyslexia and autism in respect of children with disabilities and special learning needs. As the noble Baroness, Lady Warnock, said, we are investing significantly in enhanced training for all teachers about special educational needs. We are looking at the case for more dedicated dyslexia specialists school by school, and are in strong support of the provision of dedicated specialist schools for children with acute needs. As the noble Baroness, Lady Warnock, may be aware, a few months ago I introduced a special educational needs improvement test, which local authorities must satisfy when they engage in any reorganisation of their special educational needs so that they can demonstrate that any change, including the closure of the small special schools she mentioned, must be able to demonstrate that the alternative provision that will be made enhances the quality of provision for the children directly affected and those in a similar position. Unless that test is met, a local authority should not engage in the reorganisation of provision.
	At the all-party group earlier this week the noble Earl, Lord Listowel, raised the issue of looked-after children, of which he is a tireless champion in this House. We pay tribute to his work. He raised the issue again today. As he said, looked-after children will benefit from the Children and Young Persons Bill, which we have just passed, with its radically improved legal structure to safeguard and promote their interests, particularly in respect of care placements, case reviews, social-worker support and educational attainment. He mentioned, as did a number of other noble Lords, mental health services, in respect of both looked-after children and those in the youth justice system. There have been significant improvements in mental health services in recent years, but we understand the need to improve services further, which is why the Children's Plan set out a commitment to review those services. The review was launched in December last year. Its main aim was to investigate progress made since the launch of standard 9 of the children's national service framework and the publication of Every Child Matters in 2004 in delivering services to meet the educational, health and social-care needs of children and young people at risk of experiencing mental health problems, and to see what further improvements we should carry forward in due course.
	The speech and language therapy review conducted by John Bercow and mentioned by the noble Lord, Lord Ramsbotham, is also reaching a conclusion. We confidently expect that we will be in a position to lay before the House before long specific improvements that we will make in respect of speech and language services, which, as the noble Lord so rightly said, can make a transformational difference to the experience of vulnerable young children who have not had the opportunity to develop speech and language skills in the way that they should have done earlier in life.
	Our approach to disabled children, looked-after children and children with SEN whom I have just identified—identifying key priorities for reform to improve life chances significantly, setting medium-term objectives and directing investment accordingly—represents the philosophy of the Children's Plan at large. The Children's Plan builds on improvements that have taken place in recent years. Over the past decade, Sure Start children's centres have enabled us to create what is now in effect a national under-five service where none existed before, with nursery places for virtually all three and four year-olds and enhanced provision in deprived communities. I know that it is because provision for under-fives is so dear to the heart of the noble Baroness, Lady Walmsley, that we scored particularly highly in her assessments of the Children's Plan.
	In schools, pupils and teachers are achieving the best exam results ever. Last year, 61 per cent of secondary school pupils achieved five or more good GCSEs, up from 45 per cent in 1997. There has been a particularly welcome improvement in results in many of our ethnic-minority communities, where the targeting of additional support and the increased recruitment of teachers from those communities themselves has helped us to achieve significant year-on-year improvements in results, to meet the needs identified by my noble friend Lady Howells.
	The number of teachers and teaching assistants is sharply up, as is their pay, and Ofsted reports that we have the best trained generation of teachers ever. Capital investment in school buildings has increased tenfold over the past decade, and all that has been made possible by significant increased levels of education spending at large. As my noble friend Lady Massey noted, between 1997 and 2007, total spending on education in England rose from £29 billion to £64 billion, an increase of 68 per cent in real terms. That is the basis on which most of the changes have been possible.
	Having set out some of the improvements that have taken place, as I never tire of saying, my middle names are "No Complacency" and much more needs to be done to improve education in children's services, not only in England but—as my noble friend Lady Gale rightly said—in Wales, Scotland and Northern Ireland. The Children's Plan's objectives for this country being the best place in the world to bring up children referred to the United Kingdom, not just any one part of it—I should hasten to correct the first sentence of the plan. She made a particular point about the development of highly innovative models of provision in a number of areas, including areas of special educational needs. She mentioned autism in Wales in particular. Those points are well taken and I will—and indeed do—pay close attention to developments in Wales and those areas to see how we can improve our practice in England, for which I have responsibility.
	The five Every Child Matters outcomes, which we set out in our 2003 Green Paper, set out our key objectives across the United Kingdom in respect of children. They are that every child should have the support they need to be healthy, to stay safe, to enjoy and achieve, to make a positive contribution and to achieve economic well-being. The best way of addressing some of the other issues raised in the debate is for me to take each of the five Every Child Matters outcomes in turn and say something about what they mean in terms of concrete forward policy and implementation in the Children's Plan.
	The first Every Child Matters objective is for children to be healthy. As my noble friend Lady Howells said, all the evidence points to the fact that the better start that children make in terms of parental capacity and care, from the earliest months of their lives, the healthier and more successful they will be thereafter, including in education. Recent trends in society also highlight the importance of greater childcare support for young children's parents to enable them to work and to balance work and family life.
	My noble friend asked how we would develop further our under-fives' provision, particularly for disadvantaged families and those who find it hard to cope. The Children's Plan sets out our objective that, by 2010-11, nursery or reception provision for all three and four year-olds will be increased from 12.5 hours per week to 15 hours per week. The noble Baroness, Lady Howe, asked for an assurance that the voluntary and independent sector would be fully engaged in making that additional provision, and I can give her that assurance. We are also extending those increased hours of care to some 20,000 of the most disadvantaged two year-olds, particularly focusing on those who can be identified as less likely to take up their entitlement at the age of three. We are strengthening the outreach work of Sure Start centres, with a minimum of two outreach workers in every Sure Start centre in the most disadvantaged communities. The outreach workers will work predominantly with parents, often in their homes.
	In this context, I wish to highlight the role of family-nurse partnerships, under which we are taking forward models of intensive nurse-led home visiting for vulnerable first-time young parents in 10 areas of England—not only for the first weeks after childbirth, as is traditional in the case of health visitors, but right up to when the child is two years old. Thirty million pounds has been allocated to expand the family-nurse partnership scheme in the next three years. This is targeted at the most vulnerable first-time young mothers and their first child, and I am glad to be able to tell the House that the programme is taken up by 90 per cent of the hard-to-reach families to which it is offered and has been welcomed by health visitors and midwives. This model of how we can extend the concept of the health visitor, to which the noble Baroness, Lady Morris, referred, is one to which we should pay close attention in the coming years.
	In terms of children's well-being as they grow up, child obesity and unhealthy lifestyles have been of steadily rising concern in recent years. Seeking to address this issue has guided our policy on school meals, with the establishment of the School Food Trust and the raising of nutritional standards for provision in schools. Equally important is physical activity for young people. Our school sport strategy is significantly increasing sport and physical education in schools, thanks also to improved sports facilities in schools which are being made possible by rebuilt and modernised facilities, under the multibillion-pound Building Schools for the Future programme.
	Opportunities for play and recreation outside schools, mentioned by the noble Baroness, Lady Walmsley, and the right reverend Prelate the Bishop of Norwich, are equally important. This is a particular priority of the Children's Plan—hence our decision to commit £125 million over the next three years to help every council nationwide improve its play facilities. This will fund 30 new adventure playgrounds and the rebuilding or renewal of up to 3,500 play areas. This is also a key role of extended schools. The right reverend Prelate the Bishop of Norwich mentioned the role of extended schools. After-school clubs that include sport and recreation provision are a central part of extended school provision, and that is intended to ensure that we reduce social divisions between different parts of the community, not enhance them, as he said.
	The second Every Child Matters outcome is for all children to be safe. On 5 February, following the Children's Plan, we published Staying Safe: Action Plan. As the plan noted, there is much to be thankful for. Rates of sudden infant deaths and accidents have fallen in recent years, and our consultation showed that 87 per cent of young people felt that they were safe. But we know that many families cannot afford the basic home safety equipment that can help prevent accidents, so we are investing £18 million over three years in a new home safety equipment scheme that is targeted at families in disadvantaged areas.
	However, as we know, many of the threats to child safety are not of the traditional kind, but are a function of modern society. Technological advance and more commercial activity offer children greater opportunities than ever before, but also present new risks. That is why we asked Dr Tanya Byron to examine how we can protect children and young people from the harmful effects of the internet and the video games industry. My department and the DCMS have now accepted all of Dr Byron's recommendations and we will act immediately to take forward her proposals. We will, for example, put in place a simpler and more coherent classification system for rating video games, bringing the system into line with video classification and making it easier for parents to understand.
	The third Every Child Matters outcome is that children should enjoy and achieve, which brings me to the heart of my responsibilities as Minister for Schools. I share the concern of my noble friend Lady Howells and the noble Baroness, Lady Young, that our schools should be engines of social mobility for all parts of the community—and I include all races in our country—over the next generation. Our mission in the Children's Plan is simple. Every parent should be able to choose a good primary and secondary school for their child. The great majority are able to do so now, but where that is not the case, it is simply unacceptable.
	By a "good school", I mean, at primary level, a school that achieves good levels of literacy and numeracy—as the noble Lord, Lord Dearing, said—and starts to develop children's talents beyond that, including in languages, sports and the arts. I place great emphasis on all three of those areas, as many speakers have done. At secondary level, I mean a school that achieves a good level of attainment in English and maths and equips children with the qualifications necessary to go on to further and higher education or work with training. I mean a school whose pupils achieve social skills and an appreciation of sport, art, music and culture, and an understanding of the duties of citizenship, which will more broadly equip them for enjoyment and success in life after school.
	A number of continuing reforms are necessary to achieve the objective that every parent should be able to choose a good primary school and secondary school for their child. Building on the literacy hour in all primary schools, we are taking forward the recommendations of the Rose review that tried and tested systematic phonics should be the nationwide teaching method for reading, and our Every Child a Reader scheme will provide small-group and, if necessary, one-to-one tuition for children who fall behind in literacy in the early years of primary school. Every pound that we invest in literacy in primary schools to get children up to standard will be many pounds saved thereafter as regards failure in secondary school and, as the noble Lord, Lord Ramsbotham, correctly said, the small minority of children and young people who progress into the youth custody estate and to unproductive lives thereafter.
	On numeracy, Sir Peter Williams is soon to report to us on best practice in teaching and staffing. We will act on his recommendations, alongside the rollout of an Every Child Counts programme, which aims to extend from literacy to numeracy a similar small-group and one-to-one approach to tuition for those who demonstrably fall behind in the early years of primary school.
	My noble friends Lady Massey and Lady Howells asked about the testing and assessment regime in schools. The Government remain committed to tests as an element in our strategy to raise standards. However, we are looking at how we can improve the testing regime, hence the Making Good Progress pilot running in 10 local authority areas, which is looking at the introduction at key stages 2 and 3 of single-level "when ready" tests for children, rather than their having to undertake the existing comprehensive system of SATs at 11 and 14. We will look at the results of the pilots with care to see if a national reform on those lines would be appropriate.
	At secondary school level, a concern highlighted by the Children's Plan is the future of the 638 schools that are still below our floor performance level of at least 30 per cent of pupils achieving more than five good GCSEs, including English and maths. We are focusing especially on five good GCSEs including English and maths for the reason given by the noble Lord, Lord Dearing—the importance of continuing to ensure high levels of literacy and numeracy in secondary schools, as well as in primary schools. A decade ago, 1,600 schools were below this level, so there has been a good deal of improvement. But 638 schools below this level is 638 too many and we will soon publish a detailed strategy for action to reduce this number rapidly. It will include the further deployment of academies—completely new schools under independent governance, often replacing failing schools. These—as the noble Baroness, Lady Morris, said—are proving successful and popular where they have been established. It will also include measures to enhance support for leadership in poorly performing schools, including the more widespread deployment of national leaders of education who are successful head teachers specifically designated by the National College for School Leadership for their capacity to assist colleagues in less successful schools. It will also include the wider use of school federations and other tried and tested improvement strategies.
	Above all, underperforming schools—like all good schools—need good teachers. Continuing to raise the quality of recruitment and training in the teaching profession is a key priority of the Children's Plan, including what will be a crucial change in the profession—the introduction across the profession of masters-level qualifications in teaching and learning for all teachers coming into the profession. It is modelled on the long established practice in Finland and in other successful education systems worldwide, and enables teachers to upgrade their skills to masters level once they have entered the profession.
	There is much more that I could say, but I have already overrun my time. I will deal in writing with the large number of other points that have been raised. Let me say in conclusion that, as has been recognised in the debate, the Children's Plan is massive in scope and ambition and the contributions from all parts of the House have been valuable. We will take full account of them as we implement the plan. I believe that, if we do implement it successfully, we can ensure that this country—the United Kingdom—is the best place in the world for children and young people to grow up.

Baroness Massey of Darwen: My Lords, this has been a brilliant and wide-ranging debate and I thank all noble Lords for their contributions. I said at the beginning that there was an array of talent in your Lordships' House today, and that has been shown by the passionate and effective speeches. I also thank the Minister for his considered response. We all know that he is not complacent. We shall have to return to the issue of implementation later, because we are all concerned about that.
	Noble Lords have spoken eloquently and raised a number of issues. I have a page of them here that I was going to read out; but if I did that, we would be here for another 20 minutes. I think that there has been a philosophical centre to this debate, which is about children being children in a holistic sense—from whatever background they come, and whatever their ability. Children do not come in bits. We have heard about them needing love, nurturing, attention, education—above all, parenting. We have heard about the importance of play, theatre, art, music, sport, in order that they thrive. Sometimes children need compensatory programmes to help them progress. That is partly what the Children's Plan is about, and it is admirable.
	I still have concerns about implementation. I still have concerns that we must take on board the recommendations from various noble Lords and learn from good practice—we have heard quite a bit about that today. I am so concerned about those issues that I am inspired—with the approval of noble Lords—to suggest that we come back in a year's time and look at this issue again, including how we are implementing new measures. With those words, I beg leave to withdraw the Motion.

Motion for Papers, by leave, withdrawn.

Burma: Cyclone Nargis

Baroness Crawley: My Lords, I shall now repeat a Statement made in the other place.
	"I am grateful for the opportunity to inform the House on the response being taken to Cyclone Nargis. The cyclone hit Burma on the night of 2 May. It has had a devastating impact on the people of Burma: at least 22,000 people have been killed. Unfortunately, we expect this number to rise very significantly in the coming days. Some estimates already range as high as 100,000 dead. At least 42,000 are still missing. The Government estimate that 90 to 95 per cent of buildings have been destroyed in the low-lying delta region. One million are estimated to be homeless; 1.5 million people are in need of humanitarian assistance in the delta region and around Rangoon. Preliminary assessments indicate that the most urgent needs are for shelter, food and clean water.
	"The full scale of the disaster will only become apparent over the next few days, as relief teams are able to reach remote communities in cyclone-affected areas. Assessments by the UN and other international agencies have been delayed by difficulties with communications and access. The situation is becoming increasingly perilous, with relief capacity inside the country already severely stretched. This is an ongoing crisis for the Burmese people and we are working hard with others in the international community to do all that we can for the relief effort.
	"We should not underestimate the challenge of the relief effort in Burma. The cyclone struck five states and divisions of Burma: Rangoon, Irrawaddy, Bago, Mon and Kayin. Damaged infrastructure and communications are posing major logistical problems for relief operations. Access to some of the worst affected areas is extremely difficult and will hamper relief distribution. Much of the affected region is only accessible by boat, and many of the boats in that region were damaged or destroyed by the cyclone. It is therefore vital that aid workers get access to areas affected by the cyclone to help co-ordinate the emergency response and deliver aid to those in need.
	"We are currently receiving mixed signals on the question of access to Burma for international staff. There were widespread media reports this morning of UN flights being unable to land in Burma. The latest information available to my department suggests that the first flight, with seven tonnes of high energy biscuits, landed around 7.30 am, UK time, on 8 May, and the biscuits are being unloaded. It is too soon to have a view on the unloading and customs processes, but the World Food Programme is expected to report back to us early this afternoon.
	"The second flight, with 18 tonnes of high energy biscuits, has landing rights in Yangon and is currently in Dhaka. It is expected to depart today. Delays with these first two flights were due to delays in obtaining clearances. The third flight will leave Dubai today with a range of items. It also has clearance to land in Burma. The fourth flight, due to leave from Italy, is currently on hold whilst a view is taken on the capacity of the airport equipment and staff in Burma. The UN does not want to overwhelm this capacity.
	"The first Red Cross and NGO flights will seek access shortly. We do not yet know whether the Burmese Government will allow free access for international agencies to the areas affected by the disaster. We, as well as the UN and NGOs, are continuing to urge the Burmese authorities to ensure rapid access for international humanitarian staff to Burma, and then for access to the worst affected areas within Burma to manage our assistance effectively. Representations are being made at both multilateral and bilateral levels. I have spoken to Sir John Holmes, the UN's Emergency Relief Co-ordinator, who is also appealing to the Burmese authorities to allow access to UN agencies and international workers. I have spoken with our ambassador in Rangoon, Mark Canning, who has raised the issues of access with both the senior generals and the Burmese Prime Minister. I have also spoken to the Burmese ambassador here in London to urge him to facilitate rapid access for international humanitarian staff.
	"Alongside working to secure access to the affected areas, the UK has made an immediate contribution of up to £5 million—the largest single contribution made by any one country—to help the UN, the Red Cross and NGOs to meet urgent humanitarian needs, including shelter, access to clean water, food and other emergency items. We have readied stockpiles of emergency supplies, such as tents, water containers, blankets and plastic sheets, and sourced additional logistic equipment and relief supplies to be delivered by the same agencies. We are working closely with agencies on the ground to determine exact needs, and we expect to be able to allocate these funds in the coming days as needs and access become clearer. The UN flash appeal is expected by tomorrow. Yesterday, on 7 May, I met with UK-based NGOs to discuss potential DfID support. We are ready to deploy an emergency field team to help co-ordinate our assessment and response to the disaster as soon as visas can be obtained from the Burmese Government.
	"The UN humanitarian co-ordinator will be meeting the Burmese authorities later today to provide an overview of international commitments and to discuss the progress of the response. Already, over $20 million has been pledged by donors to the relief effort. In addition, the UN has announced that a minimum of $10 million will be released from the Central Emergency Relief Fund, to which the UK is the largest contributor. The Red Cross and NGOs that have a presence in Burma, including World Vision, Save the Children and Médecins Sans Frontières, are undertaking needs assessments and have begun to distribute basic emergency items, such as food and water supplies. Co-ordination mechanisms are in place between the UN, NGOs and donors on the ground.
	"Domestically, the Government of Burma have pledged around $4.5 million for relief and have established an emergency committee headed by the Burmese Prime Minister. The Burmese Government have reiterated their readiness to accept international assistance but are only just starting to allow in UN aid. The challenges of the relief effort would daunt even the most developed country and it is important that the Burmese Government accept all offers of international assistance offered to them.
	"As the House will be aware, as well as our initial pledge of £5 million for the relief effort, the UK is one of the few countries providing long-term humanitarian assistance inside Burma. In October 2007, the UK announced that it would double its aid for the poorest people in Burma from £9 million per year to £18 million in 2010. Our support is delivered in accordance with the European common position—through either the UN or other reputable NGOs. None goes to the central Government.
	"This is a very grave crisis on a scale not seen since the tsunami of 2004. I want to assure the House that the British Government will continue to work to bring assistance and relief to the suffering people of Burma".
	My Lords, that concludes the Statement.

Baroness Rawlings: My Lords, I thank the Minister for repeating the Statement made by the Secretary of State earlier today in another place. Our thoughts and prayers are with those who have lost friends and relatives in this tragedy and who are struggling to survive the aftermath of this terrible disaster.
	It is clear that the situation in Burma is a massive humanitarian catastrophe of the like not seen since the Asian tsunami of December 2004. Reports coming through are that the death toll may well rise much further and that, as of now, hundreds of thousands of people are beyond the reach of the relief effort. The danger now is that hunger, disease and the lack of access to clean water and shelter will add to the suffering.
	We on these Benches welcome the actions outlined in the Statement. The staff at DfID are some of the finest development professionals in the world. Their compassion, commitment and expertise have a vital role to play in this current crisis. In particular, we salute the work of Rurik Marsden, who leads DfID's efforts in Burma, and our ambassador, Mark Canning, whose knowledge and insight are second to none.
	It is already clear that British charities, including the Red Cross, and NGOs are at the forefront of work on the ground. Save the Children, led in Rangoon by Andrew Kirkwood, has 35 offices and 500 staff on the ground in Burma and has already been able to help 50,000 people. It is deeply regrettable that the Burmese Government have consistently run down and undermined the UN mission in Burma, not least by forcing out Charles Petrie, the impressive former head of the UN mission there. His experience and dynamism are sorely missed at this time of crisis. The Burmese people and the international relief effort are the losers from that misjudgment by the Burmese Government.
	It would be very interesting to know exactly what relief work is being done by the Burmese Government themselves, apart from the pledge of $4.5 million that we heard about from the Minister. Can the Minister update the House on this important matter? It is a scandal that five full days after the disaster only a trickle of aid is getting in from the outside world. Can the noble Baroness tell us whether the Burmese Government are still insisting on onerous visa restrictions for aid workers? Visas have always been tricky for Burma—I remember that during the time of the communist regime. Even if aid workers get a visa, is there any guarantee that they will be allowed to leave Rangoon without waiting for up to two weeks for a travel permit? After the Bam earthquake of 2003, Iran waived visa restrictions on foreign relief workers for five days, even letting in people from America and Israel. That spirit could prevail again now. The Burmese Government should give unfettered access to the international humanitarian relief effort.
	A key lesson from the tsunami is the need for the international response to dovetail with the local relief effort. Trying to go against the grain does not work. We need to persuade the Burmese authorities to be as co-operative as possible. Aid workers are there for non-political, humanitarian reasons—to save lives—rather than for political positioning. I trust that this has been made clear to the Burmese Government.
	As the noble Baroness said, the key requirement now is for a professional and highly competent relief operation centred on money, food, clean water, shelter and medical relief. As is clear from the experience that we gained from the Asian tsunami, we need to make certain that the aid we give is exactly what is needed and that it goes to the right people. Inappropriate aid and aid that ends up in the wrong hands are as bad as no aid at all.
	As the regime's suspicion of the West is well documented, does the Minister have any reports of aid being given by Burma's hugely wealthy economic friends of the regime, such as China and Malaysia, which have substantial investments in what was, and potentially is, a very wealthy country? In the run-up to the Olympics, many eyes will be on China to examine the role that it plays in helping to make certain that the Burmese Government open up to the international relief effort. What discussions has the Secretary of State had in recent days with the Chinese ambassador in London, Madame Fu Ying, to underline this point?
	There are reports that the Burmese Government intend to impose taxes and duties on planes that take in aid supplies. Is that the case and what representations have the British Government made to the Burmese Government to suspend these tariffs?
	In the aftermath of the tsunami, concern was expressed about the operation of gift aid tax relief on donations to the humanitarian appeal—at this early stage, what steps are the Government taking on this matter?
	It is difficult to talk about good coming out of this terrible event. However, as in the case of the Indonesian province of Aceh, devastated by the 2004 tsunami, the shock and turmoil of a natural disaster can, in some circumstances, lead to movement and progress on thorny political conflicts for the greater common good. Clearly, all of us who have been vocal critics of this pariah regime, and of the former communist regime, will put politics to one side as we strive for an effective humanitarian response.
	Once again, I thank the noble Baroness for repeating this Statement. In the same spirit, I hope that she will continue to keep the House informed through Oral and Written Statements.

Lord Avebury: My Lords, we, too, are grateful to the Minister for repeating the Statement. We agree with the noble Baroness, Lady Rawlings, that what we see at the moment is only the beginning of what may prove to be an even worse humanitarian disaster than is indicated by reports so far.
	There are 42,000 people missing in addition to those killed; moreover, there are fears, as the noble Baroness said, that with the lack of clean water and sanitation, the failure to pick up the dead bodies and the lack of medical supplies reaching those needing it in the isolated regions, the ultimate toll will be very much higher than estimated so far.
	However, after initial hesitation, at least the Burmese authorities are allowing supplies to come into the ports and airports and beginning to relax the difficult restrictions they have imposed on aid workers. I am told that there are still delays, but that these have been reduced to two or three days, which may be ascribed as much to bureaucracy as actual obstruction by the Burmese regime. However, the position is improving and supplies are coming in from many sources.
	However, I wonder whether the noble Baroness will confirm one disturbing report. She mentioned supplies from China. There was a Deutsche Presse report that supplies coming in from China, but also Thailand, had been purloined by the regime and incorporated into their military stocks. That would send an adverse signal to those bringing in supplies that the military regime was using them to exploit its own political purposes. The WFP had good reasons for refusing to hand over their stocks, held in Rangoon, to the military—as demanded by the junta. Does the Minister agree that we need protocols for the management and distribution of relief supplies to ensure that the regime does not appropriate them for its own ends? How are we going to get those in place?
	We noted that a number of UK charities, including Save the Children, CARE, World Vision and the Red Cross, are already operating in Burma and we warmly congratulate them on their efforts so far. We also note that the Disasters Emergency Committee is making a consolidated appeal for contributions which I expect the public will generously support, as they have done in previous emergencies. I also welcome, as did the noble Baroness, DfID's initial contribution of £5 million and would be grateful for information on how that money will be allocated, and particularly on whether—and, if so, what amounts—it will be given immediately to the UK-based agencies that, as I have mentioned, are already operating on the ground.
	What will the logistical arrangements be for receiving and distributing large inflows of foreign aid? The constraint is probably more in relation to airport and port capacity to receive supplies rather than the permissions being granted.
	The noble Baroness confirmed that several flights are on the way. I understand that UN agencies are looking to set up what has been called the cluster approach, which has been tried and tested in other emergencies. I hope that the Rangoon authorities will accept this as the best means possible of ensuring that the logistics work—there would be a special cluster on logistics in accordance with arrangements made in other emergencies. However, will these efforts be financed by the UN central emergency relief fund, to which, as the noble Baroness has said, the United Kingdom is the largest single country donor? What agency will be responsible for the management of the logistics?
	Are there any immediate plans to repair the reportedly damaged facilities at Yangon airport? For instance, I have been told that the runway lights are not operating and that the landing of a Red Cross plane, which is in flight and on the way there, may be in question. Apart from that, there are hundreds, if not thousands, of destroyed roads and bridges. Many worst affected parts of the country may be inaccessible by land—such as the remote district of Labutta, where a military official puts the death toll in that region alone as high as 80,000 people. Therefore, will the UN be responsible for assessing the need for helicopters and, in the case of the delta, for flat-bottomed boats, to supplement the one that the British agency, Merlin, already has on site?
	Finally, does the noble Baroness agree that, as the enormous scale of this disaster becomes apparent, this is yet another reason for abandoning the sham referendum that is planned for this weekend?

Baroness Crawley: My Lords, I thank the noble Lord, Lord Avebury, and the noble Baroness, Lady Rawlings, for welcoming and supporting the Statement. I underline the praise for DfID staff, both here and on the ground in Burma. They are absolute stars.
	We have had encouraging up-to-date information. We are beginning to get co-operation over access. There is an international Red Cross flight in the air, which we have been waiting for. The Burmese have also promised visas for our three-person DfID field team to be issued at 4 pm tomorrow. On the strength of that, we are getting our team ready to go out on a flight tomorrow morning. Of course, this will be a test of the promises that we are receiving from the Burmese Government. The team's role will be to assess the situation on the ground, to network with other NGOs and UN agencies and to report back so that we can fill in and have a full response to our current DfID response. The noble Baroness asked me for an up-to-date situation; I hope that that is encouraging.
	The noble Baroness, Lady Rawlings, also asked exactly what the Burmese military regime is doing at present and she and the noble Lord, Lord Avebury, wanted me to go into more detail about the $4.5 million. Is the regime doing enough? We understand that it is providing a significant response under extremely difficult circumstances but that it clearly needs international assistance. The Burmese Government have pledged $4.5 million for relief and have sent military and police units as part of the rescue and clean-up operation. They have also established an emergency committee, headed by the Prime Minister, as I said in the Statement. They have stated their readiness to accept international assistance but they are not clear about the extent to which they will allow agencies sufficient access to manage the delivery of their aid. Discussions around access are continuing between the agencies and the Burmese authorities. Foreign ambassadors were called to a briefing by the Government of Burma on the afternoon of 5 May, when the Foreign Minister made a plea for assistance, including for building materials, medicines, blankets and mosquito nets. We agree with the noble Baroness that Burma should allow the UN full re-entry to the country. We hope that these recent assurances will allow that to happen.
	The noble Baroness and the noble Lord asked about other donors, in particular those in the region. Britain has made the biggest pledge so far but others, including Burma's neighbours, are contributing. The US has pledged $3 million, on condition that US experts be granted access to the country and the disaster-struck area. Canada has pledged just under $2 million. China has pledged $0.5 million to the Government of Burma, with a further $0.5 million pledged in kind in the form of tents, blankets and biscuits. Germany, Indonesia, India, Italy, Japan, the European organisation ECHO, the Netherlands, Singapore, Spain and Thailand are also donors in one way or another.
	The noble Baroness asked about tariffs. We have been told that tariffs are being suspended but, again, that has yet to be tested. The noble Lord asked about access. As I said, we hope that the situation is improving and we are working day and night to ensure that. We do not know whether supplies from China and Thailand have been purloined by the regime, but it would be appalling if they had been. We understand that the UN deliveries are so far secure and remain under UN control.
	The noble Lord asked about protocols for distribution. The main priority at the moment is to get our people in there, on the ground, to assess and then to start looking at the management and the distribution. I was asked how we are distributing the £5 million pledged by the UK. It will be distributed between UN agencies and NGOs. The noble Lord also asked about the World Food Programme consignment. As far as we understand, it is being delivered to a World Food Programme warehouse, not to a Burmese army warehouse. I cannot give a clear picture on the Yangon airport facilities, but I will come back to noble Lords on that as soon as I can. As noble Lords can imagine, on this whole area affected by this dreadful disaster, we are desperate for clarity.
	I was asked about the need for helicopters and boats. DfID has already opened discussions with the MoD. We do not believe that at present DfID needs military equipment, but the situation is, of course, ongoing. After we have access, we will continue to talk not only to other government departments but to the UN about this. We now have ready access to a large civil, rather than military, boat for equipment.
	I think that I have covered most of the questions asked by the noble Baroness and the noble Lord. I am sure that we can pick up others later.

Lord Hurd of Westwell: My Lords, access is clearly crucial, as the noble Baroness said, and her supplementary answer was a little more hopeful on that. However, as she also said, signals are mixed. She will have seen the remarks attributed to the French Foreign Minister, Mr Kouchner, in which he talked about the possibility of invoking the relatively new UN right to protect to make sure that the aid gets through. He mentioned it in the context of French warships being in the vicinity. He also specifically mentioned British warships, although it is not clear what he had in mind. Can the noble Baroness tell us what Royal Navy ships are in the vicinity and what instructions they are operating under?

Baroness Crawley: My Lords, I understand that the Royal Navy ship the "Westminster" is about three days' sailing away. A French warship—the "Mistral"—is, as the noble Lord, Lord Hurd, said, in the Andaman Sea. Obviously, as the situation develops, both those facilities will be there and available. I understand that the UN responsibility to protect was conceived to address four defined situations in which Governments have failed to protect their people: war crimes, genocide, ethnic cleansing and crimes against humanity. The current situation does not fit clearly into these categories. It is important to recognise the different views within the Security Council on this issue. As the noble Lord, with all his experience, will know, the absolute priority is humanitarian and we must be alive to the risk that threatening the regime will make that more difficult to address.

Lord Kinnock: My Lords, I thank my noble friend for the Statement and join her in expressing admiration for all those from every nation, including ours, who are striving to assist the wretched people of Burma. Does she agree that, although these are not conditions in which strident political sentiments should be expressed, it is impossible to avoid making the observation that it is a tragic absurdity that the huge state apparatus controlled by the junta in Burma, which so recently and ruthlessly could suppress popular protest, has not been used quickly or properly in trying to bring relief to the people of Burma and to prevent the even greater carnage that will come from the terrible disruption and the spread of disease?
	Will my noble friend ensure that our Government express their thanks to countries in the region, which are already evidently active in trying to aid the people of Burma? In doing that, will the Government do two other things? First, will they urge countries such as China, India and Malaysia to increase their efforts? Secondly, will they establish whether those countries are willing to transmit aid from other parts of the world into Burma, as it is likely that they will get much better access much more quickly than will those agencies, including UN agencies, from elsewhere on the planet?

Baroness Crawley: My Lords, my noble friend Lord Kinnock is absolutely right. We are continuing to talk intensely to our colleagues in China, India, Malaysia and Thailand to ensure that their position, both politically and geographically, is used to the maximum. We will ensure that the time for political discussions on how we feel about the situation in Burma is not lost. We in this House have a sterling record of ensuring that we discuss Burma continually and, politically, we will come back to that, but we will talk to our friends in the region continually to ensure that food gets through.

Viscount Slim: My Lords, I think that the noble Baroness is aware that I go to Burma, Myanmar, from time to time and am concerned with some four rather specialist charities that do good there. I worry a little about our embassy. Compared to the number, size and staffing of other embassies, we are very tiny; it is almost a one-man band. We have had and have now a most excellent and outstanding ambassador, but I have often wondered why we do not have a defence adviser. That seems rather odd. We are dealing with a military Government. We ought to try to get messages across to them; we ought to try to influence them in certain ways. Other agencies seem not to be on board. Including this immediate disaster, we could well be understaffed. I wonder whether we are not being a little stingy from the Foreign Office and DfID in manning and giving proper support and help to the embassy and its staff.

Baroness Crawley: My Lords, I do not think that we are being stingy; we are giving everything that we possibly can at present. It is not a matter of amount or quality; I know that it is to do with access and not having a clear picture of the situation. However, we have great confidence in our ambassador in Rangoon, Mark Canning. He is doing a marvellous job; we are supporting him to the hilt and we will continue to.

Baroness Uddin: My Lords, I salute the work of my noble friend and her department, DfID, in their effort in numerous crises. I had the great fortune of visiting Bangladesh post-Cyclone Sidr. I travelled to the Bay of Bengal and visited Sarankhola and Patuakhali. I must tell noble Lords that it was a devastating experience. Nothing compares to the devastation that you witness after such a natural calamity. I have little idea of what is going on in Burma but, in the light of that experience, I suggest to my noble friend that she consider speaking not only to all the other countries but Bangladesh, in particular, because it has recent experience.
	I know that DfID, in its partnership with organisations such as Oxfam and Muslim Aid, has exactly the right experience. Given what my noble friend Lord Kinnock said about Burma perhaps being amenable to accepting immediate aid and assistance through other countries—not that that is what we should expect or be party to—I think that we should do everything we can to ensure that that expertise is used immediately. Will my noble friend assure me and the House that she will speak to the Government of Bangladesh and talk with organisations such as Muslim Aid, which has long-established experience of working post-tsunami and post-Cyclone Sidr in Bangladesh?

Lord Bassam of Brighton: My Lords, before my noble friend answers, I remind noble Lords that this is a session for elucidation and questions, not a session for debate.

Baroness Crawley: My Lords, first, I thank my noble friend Lady Uddin for sharing her direct experience of disaster relief. I hope that it will encourage her to hear that the DfID office in Bangladesh is already sharing its experience with DfID in Rangoon.

Lord Hannay of Chiswick: My Lords, perhaps the Minister will reply to a question from the noble Lord, Lord Avebury, which she did not reach, which concerned the implications for the constitutional referendum this weekend. It seems to me an act of extraordinary insensitivity to the suffering of the people of Burma to go ahead with that project. I do not want to characterise the nature of the project during questions and answers about humanitarian matters, but it seems rather insensitive.
	Secondly, can we not get away from the concept of the responsibility to protect being a military concept? It is not a military concept; it is a normative concept of international humanitarian law. It applies just as much to the situation in Burma now as it does to the situation in Darfur, Zimbabwe or anywhere else. The military aspect comes only if everything else fails. Can we not somehow get references to the responsibility to protect out there in the open as a civilian concept—a concept in which both the international community and the authorities in Myanmar have responsibility to protect those people? That should lead to lifting of the restrictions, free access for all humanitarian agencies, and so on. We really must not mix that up with the idea that somehow or other we will force aid by military means. That is uniquely difficult.
	I was in Burma only three months ago. It was a beautiful and tragic place when I was there; it is now a much more tragic one. I welcome what we are doing to help them.

Baroness Crawley: My Lords, given the noble Lord's direct experience of Burma, I say to him that, as we understand it, the constitutional referendum is to go ahead in those areas unaffected on the original date; it is to go ahead in affected areas by the end of the month. The noble Lord will know our position: we were very robust recently in an Answer to a Question he asked about the constitutional referendum. That is the position as we see it at present.
	The noble Lord asked what the UK has been doing to persuade the Burmese Government toward democracy. The UN common position and sanctions against the Burmese regime were renewed last month, as he will know. The UN Security Council issued a presidential statement on 2 May ahead of the 10 May referendum underlining the need for an inclusive and credible political process in Burma. That recognises the obvious shortcomings in the regime's road map for political reform, which is simply intended to reinforce long-term military control in Burma.
	The noble Lord returned to the UN Security Council right to protect. There is no doubt that the Burmese Government have a responsibility—a civil responsibility, as he put it—to act, and to act now to save the lives of hundreds of thousands of souls in Burma suffering after the cyclone. We must convince the regime to co-operate and are using all available channels to urge them to facilitate the international effort. We hope that they will listen to their friends in the region, who have made that point strongly, and to the UN Secretary-General, who has urged maximum co-operation.

The Lord Bishop of Liverpool: My Lords, we very much welcome the Statement by Her Majesty's Government, and we enormously appreciate the lead that they have given, especially in the size of the donation. The noble Baroness read out an encouraging list of countries that have already pledged their support. Your Lordships' House will recall that in the tsunami crisis a similar list of countries pledged support, but subsequently we heard stories in the media that these pledges were not honoured and the money did not come forward. Could such a protocol be constructed so that countries were held to the commitments that they make publicly, so that when this terrible disaster has passed out of the media's interest but the humanitarian need remains, money, aid and development will still flow to those people who need it?

Baroness Crawley: My Lords, it is our will that all the countries to which I have referred will not only make pledges but continue to honour those pledges. We will continue to honour the pledges that we have made. As well as the £5 million which DfID has pledged this week, we have increased our long-term aid to Burma and believe that that is an example to be followed by other countries.

Lord Crickhowell: My Lords, the noble Baroness mentioned helicopters briefly in response to a question from the noble Lord, Lord Avebury. The worst of this disaster has occurred in the Delta region, which is substantially under water as a consequence. The experience of the tsunami showed that substantial helicopter support was absolutely essential, and was provided on that occasion largely by the United States offering some of their aircraft carriers. Is there any indication that the regime is likely to allow the use of helicopters from outside, and is action being taken at this stage to press it on what is likely to prove to be an extremely important matter?

Baroness Crawley: My Lords, the noble Lord makes a crucial point. In our discussions with the regime, we have continually wanted to ensure that the parameters of our action are as wide as possible. We have made that clear to the Burmese Government. We are taking incremental steps. At present, we need to get access. However, our discussions are not about narrow access but about whatever access is needed to help these hundreds of thousands of people. As I said, we have opened discussions with the MoD on the possible use of military equipment. That is where we are at present.

Lord Elton: My Lords, has the area of damage extended into those areas of Burma where the present regime has been exerting its most repressive measures against the indigenous population, notably in the homelands of the Karen and Karenni people? If so, will the Government undertake to exert their greatest efforts to see that aid is available there? Secondly, is any move afoot to have a central point for charitable donations to be made in this country, as there was during the tsunami?

Baroness Crawley: My Lords, on the noble Lord's last point, I understand that there will be a flash appeal for relief tomorrow. On the ethnic areas and the people who have been persecuted so dreadfully by their government in the past, although the Karen state was affected by high winds and rain, it is not among the areas that have been worst hit by the disaster. Our emergency assistance for the cyclone will not cause any reduction in our support for Burmese refugees on the border area in Thailand. We are discussing this year's contributions with Christian Aid and the Thailand Burma Border Consortium, taking full account of our recommendations of last year.

Lord Fraser of Carmyllie: My Lords, a parallel has repeatedly been drawn with the tsunami crisis of a couple of years ago. I recall when I went to the Maldives for a holiday that my friends in Scotland said that I was under a moral obligation to stuff my pockets full of dollars and distribute them in the Maldives, because that was the only way in which they could be confident that the money would get to the people who really needed it. Apart from the great generosity which I acknowledge the noble Baroness has offered through DfID, does she see that there is an obligation on government to remove that sense of cynicism that is growing in this country? We are a naturally generous and compassionate people, and if that cynicism can be removed I am very confident that real generosity will be shown in the appeal tomorrow.

Baroness Crawley: My Lords, I absolutely agree. We have to go beyond a sense of scepticism. Sometimes scepticism is very well founded, and it is right that Governments should be pressed on this point. DfID's record, as the noble Lord has said, is very good in this respect. We are very accountable for what we pledge and what we spend. However, the Red Cross appeal and the UN appeal need people to come out in very generous numbers to help these people. They are in great and grave need.

Poverty

Lord Bilston: rose to call attention to the objective of tackling poverty through helping people into work and improving life chances, together with incentives and protections; and to move for Papers.
	My Lords, the subject of this debate—tackling poverty by improving life chances—has been at the heart of Labour's philosophy since the Labour Party was founded over 100 years ago. Abject poverty in the midst of great wealth was the order of the day for millions of British families whose life chances were blighted by unemployment, wars, lack of education, disease and malnutrition, and in many families early death. It is therefore unsurprising that the party that I have been proud to be a member of for almost 50 years has the elimination of poverty, in all its forms, as its abiding mission.
	At the top of my agenda for tackling poverty and improving life chances is the opportunity for employment. In our society, the independence and freedom that a wage packet or salary cheque bestows can liberate the spirit and engender confidence, self-worth and a sense of well-being for the individual and his family. Conversely, unemployment destroys a human being's sense of dignity and pride, creates a climate of uncertainty and financial turmoil, and generates a poverty of the spirit which denies ambition and aspiration.
	The mass unemployment of the 1980s remains indelibly etched in my mind. I was one of the 3 million unemployed at the time. Our Bilston steelworks was closed with the loss of 2,300 jobs. Factory after factory went out of existence, and 40 per cent of the Black Country's manufacturing base was wiped away. Levels of unemployment ran at 30 per cent, and in some streets it was as high as 50 per cent. Some 35 per cent of our young people were denied their first opportunity of employment since leaving school. Training places were almost non-existent, and the careers service was moribund. A depressing sense of hopelessness and despair pervaded our whole community. Soon poverty made its degrading presence felt, and for many human beings, life chances were abruptly truncated at a crucial stage in their lives. Sadly for others, their life chances ebbed away at the moment of their worklessness, never again to return.
	Those are the reasons why the Government's commitment to full employment should be applauded and enthusiastically encouraged, particularly in a turbulent global economy where many decisions on investment and the employment of British workers are now taken thousands of miles away. It is self-evident that all partners in Britain plc—government, manufacturing industry, the financial and services sectors and trade unions—all have a vital part to play in the operation of the sound and dynamic economy that is axiomatic to a successful trading nation in the 21st century.
	The virtuous link of full employment in the pursuit of tackling poverty and improving life chances together with the achievement of increasing national prosperity is an economic and social justice model that should bind us all. We should therefore celebrate the fact that Britain has the highest employment rate in the developed world, higher than the United States, Japan, Germany, France or Italy. We now have the highest level of employment ever recorded in this country, while unemployment continues to fall. Despite the vagaries of recent financial turpitude, Britain now enjoys the lowest unemployment rate in 30 years. It naturally flows from my own experience of unemployment that I want the Government to go further. The 80 per cent full-employment aspirational target recently announced will need a co-operative and sensitive government approach to people on benefits, job seekers and lone parents if the concept of employment for all is going to be a reality.
	Social justice and fairness must always dictate how government respond to the needs of the poor, the weak and the vulnerable—the least fortunate in our society. The concept of the strong protecting and defending the weak has a resonance in the conscience of any civilised society. It requires a fair and adequate distribution of wealth and income and a high quality of service provision if the historic moral and social imperative for greater equality in society is to be fulfilled. The resolution of child and family poverty, low pay and income disparities in old age go to the heart of this industrial mission, and I believe that it is right to claim that the work in progress by this Government has achieved a greater success than any previous Government in their search for the Holy Grail.
	The chosen method of income distribution that this Government have so far adopted is a combination of universal and targeted benefits to individuals and families, additional weekly income through child, family and working tax credits, pension credits, and the introduction of the minimum wage. A prerequisite for the maximum take-up of these targeted benefits, which are central to the Government's effectiveness in reaching those in need, is a concerted effort by the Government to communicate knowledge and ensure uncomplicated access to the payments and benefits.
	Another beneficial contribution that the Government made to tax fairness in last year's Budget was the historical reduction to a 20p income tax band which will significantly help millions of families. However, it would be churlish not to acknowledge the self-infliction of electoral damage and unpopularity brought about by the recent abolition of the 10p tax band. I share with all noble Lords our satisfaction that this vexed matter will be addressed.
	However, if Labour is to fulfil its historic purpose then more radical plans on wealth, capital gains, income redistribution and taxation will need to be adopted. There is, for instance, a justifiable case for tax increases on the top 10 per cent of income tax payers. In order to show some sympathy and solidarity with the present plight of millions of our citizens who are struggling to pay excessive utility and fuel bills, the Government should introduce a windfall tax on blatant profiteering. They should also refer some food price increases to the Office of Fair Trading and cancel the fuel excise duties proposed in the Budget. These measures would considerably help to heal the hurt felt by electors last Thursday.
	I return to my theme of tackling poverty by improving life chances. The Government have made a determined contribution to reducing child poverty. During their term of office an ambitious target has been set to halve child poverty by 2010 and to eradicate it by 2020. Alistair Darling, the Chancellor, made another generous contribution in this year's difficult Budget of £1 billion to help families on low incomes. If this majestic goal can be achieved, if we can show the determination, the will and the means to succeed, then a human triumph over impoverishment and the immorality of child poverty will be the prize. The elimination of child poverty will illuminate and enrich the life chances and opportunities of millions of our children and young people. The gains for society will be huge—greater social and family cohesion; the abatement of criminality and dishonesty; and a deeper sense of happiness and enjoyment of life and living, both personal and communal. For all these noble achievements, the price must be well worth paying.
	Unfortunately, time will not permit a lengthy explanation of other government initiatives dedicated to tackling poverty by improving life chances. Suffice it to say that the Government's approach to education will find a panoply of policies designed to achieve this objective. One excellent example is the creation of the early years Sure Start health and education centres, a brilliant educational concept and real success story which provides for multidisciplinary professional teams in specially equipped buildings to welcome babies and small children from socially deprived communities to educational stimulus and healthcare. These youngsters are often born into disadvantaged and dysfunctional families, but parents, single mothers, single fathers, carers and grandparents are all welcomed and encouraged to integrate into the learning, caring and education process, where healthcare, hygiene, debt, financial planning and many other important practical issues for the family are discussed. The confidence and well-being which this intervention and interaction engenders is having a profoundly beneficial effect on the early lives of hundreds of thousands of our young children, whose life chances are daily being transformed.
	Education, at every stage of development, imbues empowerment in the individual, the family and the community, transforming lives with knowledge and opening up opportunities for economic and social advancement. Therein rests the real challenge of combating poverty through improving life chances. I pay tribute to the Government for their determined commitment to the value that they place on education and skills, for the improved standards and for the record levels of investment in our schools, colleges and universities. In the words of William Morris,
	"the Cause alone is worthy till the good days bring the best".
	That day will come, when all our citizens are more equal and more equally share in the wealth that they have helped to create. That day, we shall celebrate society's triumph over poverty and despair. I beg to move for Papers.

Lord Haskel: My Lords, I cannot remember speaking in such an exclusive debate. I know we have had two debates recently on matters touching on poverty, but as my noble friend said, poverty goes to the heart of what brought many of us into politics. I heartily congratulate my noble friend on initiating this debate, because we cannot debate the subject enough. I am glad that my noble friend included both poverty and life chances in his Motion. Of course the two go together; he is absolutely right. All too often we have seen Governments adopt piecemeal responses to problems with a short-term policy solution, but not in the case of poverty. This Labour Government have used 10 years of national prosperity and sustained economic growth to make massive investments to deal with poverty. The battle is not yet won; there is more to be done.
	There are two routes to poverty: social and economic. There was a time when simple redistribution would help to lift people out of economic poverty, but not any more. Life has become a lot more complicated than that. That is because the main causes of economic poverty today are lack of work, globalisation and new technology. For some they have created prosperity, for others they have created poverty. We have a choice. We can deal with this by closing our borders and trying to keep the effects outside, or by opening up our borders and participating in globalisation and new technology. Quite rightly, we rejected protectionism and now live in an era of economic liberalism and global engagement. We are engaged in a race to the top and we need the best team that we can get. That means that everybody made poor by this competition has to be enabled to move out of poverty into better jobs. As my noble friend said, skills training, education, tax breaks for jobseekers and the minimum wage provide the means for people to improve themselves.
	Moving out of poverty by being more productive improves not only people's life chances, but the country's life chances. Once again, this Government have been absolutely consistent and relentless over 10 years in empowering people in this way. Indeed, the public and private sectors have spent record sums on training during this past year. There is more to do. The Leitch report on skills training has to be implemented, education levels raised and everybody given the opportunity to improve their life chances.
	The other kind of poverty is social poverty. For as long as I can remember, most of us have been concerned about it, but it has still not gone away. Increased prosperity and people having more power and control over their lives has changed the nature of social poverty, but it still goes on. In its recent consultation, the Joseph Rowntree Foundation identified poverty as,
	"a corrosive social evil in an affluent society, underpinning other social problems like homelessness and family breakdown".
	Family breakdown, addiction, indebtedness, dependence, disability, inability to cope—these are all causes of social poverty, and my noble friend spoke about most of them.
	Those routes to poverty have been the subject of endless study, but one thing comes across loud and clear: unless you do something to break the cycle, disadvantage is passed on from generation to generation. Every UK birth cohort study, going back to the 1940s, shows that. The way you tackle poverty by improving life chances is to start early. That is why the Government are right to concentrate on getting children out of poverty in order to break that chain of disadvantage. Again, the Government have been consistent, introducing ways of improving the life chances of poor children. My noble friend listed them: Sure Start, child tax credits, Every Child Matters and indeed the Children's Plan, which we debated just before this debate. The 1 million children whom we hope to lift out of poverty mean 1 million breaks in dependency passed from one generation to the next.
	This is not a matter of left or right politics; either you believe it or you do not. There are people on all sides who have looked at the problem and decided that the earlier you break the poverty cycle, the cheaper it is and the more effective it is. Of course attempts can and must be made later in life, but the later you leave it the more difficult and expensive it becomes. Yes, it is complex; a simple agenda of tax cutting would be more populist, but it would do little to break the cycle of poverty. Yes, Governments can deal with the big picture, but poor people are also individuals, as my noble friend Lord Bilston movingly explained.
	Problems of this kind are probably best solved locally. So I congratulate the City of Nottingham and Graham Allen MP, chairman of One Nottingham, on launching "Early Intervention in Nottingham" on 28 April. That is the kind of productive partnership between the Government and local authorities that allows anti-poverty strategies to be tailored to local needs. As I said, this is not a matter of left or right. While congratulating Nottingham on its early intervention programme, I also congratulate Iain Duncan Smith MP, who has been calling for an integrated approach to tackling disadvantage that is shared by people across the political divide. He is right. This is a generational matter, and requires sustained political attention across the lifetime of several Parliaments. Indeed, he, Graham Allen and others from all political parties and from none are contributing to a pamphlet about early intervention that is to be published by the Smith Institute next month. I hope that that will inspire more local initiatives and co-operation. Although much has been done, much more remains to be done. I declare an interest as a trustee of the Smith Institute.
	As I have tried to show, the Labour Government have consistently been concerned about poverty over the past 10 years, and have consistently tried to tackle it, whether the causes are social or economic. What the Government have probably not done is to explain why they have gone to all of that trouble and expense, and why they have made that sacrifice. Some might have said that the poor are just unfortunate victims of the market and left it there, but the explanation is that we stand for a fairer society. My noble friend described that.
	That sense of fairness is being shared by more and more people. People want fairness with less raw capitalism; they want markets humanised, so as to restrain its worst effects on the poor. That is why some of our best thinkers are now concerned about the limits of markets, and why business is very ill-advised to be using threats such as relocation to extract concessions from the Government regarding tax and regulation, for we are beginning to understand that the cost of all this is increased poverty in our country. This is a time of rising food and fuel prices, where incomes are being squeezed. How far better it is to contribute to what is being done to alleviate poverty, and to work with the Government and charities to reduce it so that we can all help to create a fairer society.

The Lord Bishop of Liverpool: My Lords, I should like to make a few comments in the gap on the speech of the noble Lord, Lord Bilston. I was hoping to be here today but could not be sure, and I am delighted to have sat at his feet and heard his contribution, because the noble Lord introduced into this subject the notion of justice. It is so refreshing, because that word has been singularly lacking in the language of urban regeneration over the past 10 to 15 years.
	When I was Bishop of Hull, I was involved with the Single Regeneration Budget; as Bishop of Liverpool, I chaired the New Deal programme for communities. Those initiatives have been excellent in trying to break the cycle of poverty, but if we listen to the language of regeneration it does not capture what the noble Lord, Lord Bilston, has brought to this debate. For example, in regeneration we talk today not of justice or fairness, as the noble Lord, Lord Haskel, said, but about triggers, levers, targets, outcomes and outputs. There is a place for that language—the language of milestones—but it is secondary; the primary language is that of justice and fairness.
	In the diocese of Liverpool, 45 per cent of my parishes are in areas of multiple deprivation. I believe that we can tackle these issues only if we have a sense of justice, and, as the noble Lord, Lord Haskel, said, if that is across parties. The language is there, but it needs to be brought to the forefront. That Single Regeneration Budget initiative was very much business-led, with a little community awareness, whereas the New Deal programme for communities was very much community-led, with some business awareness. What we need to regenerate our cities and break the cycle of poverty is, in fact, the twin engine of community and local business leadership.
	I salute the initiatives we have had over the past 10 years but, in thinking further about regenerating our cities, renewing our communities and restoring justice, I would encourage us to look at creating real jobs in a real economy, supported by both local businesses and the local community. I thank your Lordships for the opportunity to intervene in this way.

Lord Oakeshott of Seagrove Bay: My Lords, I welcome the opportunity to take part in the debate from these Benches, and I start by thanking the right reverend Prelate the Bishop of Liverpool for his very welcome contribution. A little later, I will talk about the persistence of deprivation in particular areas of this country. However, since he spoke movingly about Liverpool I might point that on the recent indices of deprivation that the Department for Communities and Local Government has just published for England, five out of the 12 most deprived local areas are in Liverpool. I am afraid that all five were, again, in the top 12 in those same figures in 2004, which starkly illustrates the persistence and concentration of deprivation in certain areas.
	Despite all of the Government's efforts—and I will come in a minute to what the noble Lord, Lord Haskel, was saying—in many areas their policies are, unfortunately, not really working. I want to inject that note into the debate and to identify and look at whether the policies are working and to support the very constructive tone of the debate. Our aims are all the same, but after 11 years of Labour government we need to take a long, hard look at which policies are working, and for whom, and which are not.
	Like the noble Lord, Lord Haskel, these Benches reject protectionism—he is right about that—and like him we say that there are limits to the market. The climate in this country is changing fast. It is important that we all accept and understand that. The culture of greed, the bonus culture in the City and the idea that one should not talk about social justice are changing fast. We should all be aware how fast that climate is changing.
	I thank the noble Lord, Lord Bilston, for introducing the debate. He may not remember, and I am sure he will not—but I do—that 35 years ago, when he was just Dennis Turner, he beat me for the nomination for Halesowen and Stourbridge. Perhaps he does remember that. I think that I had three nominations. He may not have had so many but he did better and very nearly won the seat. He then went on to win Wolverhampton South East, formerly Bilston, on which I congratulate him, which he represented for many years, and about which he spoke movingly.
	After 11 years of Labour government, more than 9 million people of working age are unemployed or receiving benefit. More than two and a half million of them are on incapacity benefit, of whom more than a million suffer from mental health problems. That figure has risen dramatically since 1979, when it stood at only 800,000. That is not a party point as successive Governments, both Labour and Conservative, have used incapacity benefit to hide unemployment. Although there is now broad consensus that that is wrong, we are dealing with a legacy of very long-term under investment in people.
	We believe that work is good for most people. It is the best route out of poverty and provides benefits in terms of confidence and mental well-being. But people trapped in long-term inactivity, many of them in areas and regions of deep-seated deprivation and economic decline, as I said, need a helping hand into work, not a kick in the teeth when they are down. I am afraid that is the risk with the way in which, from time to time, the Government present their programme to get people off incapacity benefit. By chasing cheap headlines in the Tory tabloids, they make people without jobs defensive and fearful that their meagre benefits will be cut, instead of encouraging them to engage constructively and take up the help on offer. By playing fast and loose with ministerial undertakings—I am afraid that I have to say this—given during the passage of the Welfare Reform Act, they are in danger of getting a good policy a bad name.
	As well as focusing on the evidence of persistent regional deprivation, I also want to talk about aspects of the alarm call in the report of the Merits of Statutory Instruments Committee on the Employment and Support Allowance Regulations, published last week, which stated:
	"These Regulations are drawn to the special attention of the House on the ground that they give rise to issues of public policy likely to be of interest to the House".
	Your Lordships will know that is Merits of Statutory Instruments Committee-ese for showing the DWP the yellow card.
	The report also stated that,
	"a number of organisations have written to the Committee to express considerable concern that the Regulations do not meet with their understanding of the Government's intention ... The Regulations are complex and claimants may find it difficult to understand the operation of this allowance. The Government need to do more to explain how this system will work and to address the concerns of interest groups that are in a position to offer significant assistance in helping claimants understand the new system".
	I do not propose to ask the Minister to comment on each of the bodies individually but I am sure that he will respond generally to the points that we make.
	These organisations—the Disability Benefits Consortium, the Citizens Advice Bureau, the Child Poverty Action Group and the Disability Alliance—have written in and make the very effective and powerful points. Their main point is that the ESA rate for single people of £89.50 does not exceed the current rate of incapacity benefit, contrary to government undertakings given during the course of the Bill, and earned income and tax may have a perverse effect on a benefit designed to help people back into work. They are also worried about the potentially negative effect of these changes on households which include children, and restrictions on disabled students pursuing a course of study.
	The Government say that they do not accept that the rates which have been announced are incompatible with Statements made to Parliament:
	"The rate of £84.50 for those in the work-related activity component is above the rate of long-term Incapacity Benefit (£81.35) at the time the statements were made".
	Those are weasel words if ever I heard any and the Disability Benefits Consortium's letter makes that point. It says:
	"We believe that the regulations ... do not fulfil important commitments and reassurances given to ourselves and to Parliamentarians".
	The Disability Benefits Consortium thinks that up to 40,000 children could be affected by a fall in income from the family from these changes and that that is completely contrary to the Government's commitment to eradicate child poverty. To quote the noble Lord, Lord McKenzie:
	"We have made it clear that, in the main phase, the basic allowance will be above the long-term IB rate".—[Official Report, 20/2/07; col. GC 9.]
	As I have already stated, the figures do not seem to back that up. The consortium also says:
	"The basic allowance of ESA is £60.50. But during the initial 13 week assessment phase under 25 year olds will receive a lower amount of £47.95. For those eventually entitled to the main phase, they will have had to survive for 3 months at £36.55 less than it is ultimately decided is their necessary weekly income".
	On passported benefits, the consortium says:
	"The starkest injustice for this group of contribution based claimants results from how permitted work earnings will be treated in calculations for Housing Benefit and Council Tax Benefit entitlement".
	And,
	"The difference amounts to over two and a half thousand pounds per year. It is against the principle of national insurance for those who have paid into the system to be left worse off as a result by such a massive amount".
	The CAB is equally concerned. It focuses on passported benefits—and there is obviously a more general problem with the benefits system on the complex nature of means testing—and points out:
	"Under the new arrangements, people who are in receipt of income-related ESA will be automatically passported to these benefits; people whose only income is ESA(C) will have to apply separately for each one".
	So that is a separate means test, making the claiming process for this group of low-income, disabled people much more difficult than necessary. It concludes:
	"We believe it is an absolute and essential requirement of any legislation that it should be demonstrably fair and we are concerned that ESA does not meet this criteria".
	The CAB is at the sharp end and has to deal with the problem on the ground.
	Finally, the Child Poverty Action Group, which again is very close to the action, if I can put it like that,
	"are concerned that some of the most severely disabled claimants may be subject to unnecessary stress and difficulty in the assessment of their entitlement to Employment and Support Allowance, because the regulations do not provide that they are automatically treated as having a limited capability for work".
	Those are detailed but important points and, as I said, there is a great danger that a good policy will get a bad name unless these very real concerns from very reputable organisations are seriously addressed.
	I turn now to the regional dimension and the persistence of unemployment, on which I touched previously. We have obviously talked a little bit about how incapacity benefit is a form of hidden unemployment but it is also quite interesting to look at the actual published unemployment rates over the past 11 years since 1997. In general, there has been a very worthwhile fall, but the problem is it has not been equal throughout the country. The 10 constituencies that have the highest unemployment rates are Birmingham Ladywood, Birmingham Sparkwood, Liverpool Riverside, Birmingham Hodge Hill, Manchester Central, Liverpool Walton, Leeds Central, Middlesbrough, Bethnal Green and Bow and Birmingham Erdington; and the pattern is continued lower down. Those with the highest unemployment rates today are also the ones where the fall in unemployment since Labour came to power has been the lowest. In every single one of those constituencies, the fall in unemployment has been less than the national average over the past 11 years.
	I give just one further example. I thought I would look at the former constituency of the noble Lord, Lord Bilston, about which he spoke so movingly. Wolverhampton South East, where unemployment is now 13th highest in the country, was 577th in the league table of how fast unemployment has fallen since Labour came to power. The places with the biggest problems, which are the Labour heartlands, are the places that have suffered the least improvement. That must be a very worrying pattern.
	The index of multiple deprivation I touched on briefly in response to the right reverend Prelate. We had one in 2004 and one in 2007. The index of deprived areas is a multiple deprivation measure. The two key points are income and employment deprivation, which are obviously related. They account for about half the definition. The problem, again, is persistent and concentrated deprivation in certain regions. Both in 2004 and 2007, no fewer than 46 out of the 50 most deprived areas were in the three regions of the north-west, Yorkshire and the Humber and the north-east, with a very heavy concentration in the north-west. That is not changing. Again, if one looks at the unemployment figures at the other end—the places where the improvement has been fastest—one sees that they are constituencies such as Boris's and Dave's, if I can put it that way, which are Witney and Henley. The rich areas and the Home Counties have had the fastest improvement. It has been unfortunate that, while overall there has been some progress particularly on child poverty, it has not been getting through to the areas that really need it and the areas that really matter.
	I do not propose to go into the 10p tax mistake today, although the noble Lord touched on it. It was not a reduction; I do not think that a 10p tax rate is the very best way to help people out of poverty. Our position is that that should not be changed unless and until measures have been taken particularly to increase the tax thresholds and to take more people out of tax altogether at the bottom. That is the right way to do it. I suppose that I had better ask the noble Lord, since the architect of new Labour has very helpfully made the point today, whether he agrees that scrapping the 10p starting rate in tax was a big mistake.
	It is not surprising that the problems or disillusionment that we saw last week was most striking in what I call the Labour heartlands. We understand why they feel let down. From the statistics that we have seen, and from the points that the noble Lord, Lord Bilston, made, we can see that, for all the good intentions, achievement has lagged well behind that in the poorest regions of our country. I look forward very much to hearing what the Minister has to say, not just on the individual initiatives, but in particular on how they can be linked to long-term investment in our regions. It is much more about regional policy. It is no good telling people to stop shirking and start working if they live in places where there are very few worthwhile jobs within reach. Somehow, that form of joined-up government really needs to start.

Lord Skelmersdale: My Lords, as the noble Lord, Lord Haskel, remarked towards the beginning of this very short but very valuable debate, this is the third debate on poverty in two months. I congratulate the noble Lord, Lord Bilston, on achieving it, not least because, if the debate of the most reverend Primate the Archbishop of Canterbury, for which alas I was absent, showed nothing else, it showed that the Government would do well to concentrate on the reasons why there are so many people, and therefore children, in our society in poverty, rather than pouring out ever-increasing amounts of money which go only to paper over a dismal set of statistics—statistics, which in this case mean people.
	Putting people first, the number living in severe poverty defined as less than 40 per cent of the median income has risen by 600,000 since 1997. If you measure this after housing costs the situation is even worse: alongside the low unemployment figures mentioned by the noble Lord, Lord Bilston, those in severe poverty stand at the highest level for the same period, 30 years, at 5.2 million people or 8.7 per cent of the population. The Minister may dispute this—I have no doubt that he will try—but those figures are based on his department's own data.
	As was pointed out in previous debates, the average income of the poorest 10 per cent is lower than it was in 2001, which one can set against the fact that the average incomes of the richest 10 per cent have risen by more than £2,000 a year. Even the Prime Minister's Strategy Unit has been forced to admit in Strategic Priorities for the UK 2006 that,
	"the very poorest have not shared in recent growth".
	You can say that again.
	It is axiomatic that poorer parents mean poorer children, and the Government are right to seek to eliminate child poverty by 2020, and to halve it by 2010. To make this meaningful you have to define your terms, which is one of the few things I remember from my economics lessons all those years ago. The Government define poverty as households having less than 60 per cent of the median income, adjusting for family size. After falling for several years, child poverty, on this basis, it is now rising, last year by 100,000. As I pointed out in the first debate in this series, it is hardly surprising that when income is rising, so does the poverty level, so the Government are working with one hand tied behind their back. Perhaps the Government expect median income to fall. No, I am not being serious, but I am serious in saying that tackling poverty is the duty of any and every government.
	It was not helpful in this context for the Prime Minister to say on the "Today" programme on 30 April:
	"We're about to take a million people out of poverty".
	Only yesterday at PMQs this was translated to,
	"We have taken 1 million children out of poverty".
	Using the definition that the Government use and I have just described, I should have thought that the true figures are that, as of today, 600,000 have been lifted out of poverty since 1998-99. Will the Minister take this opportunity to clear up what I hope from his point of view is a confusion in my mind?
	However, pouring money into the system is only a stop gap. As the median wage increases, so more and more money is required. It is all very well as a start to do what the Chancellor committed the Government to do in his recent budget, to which I referred late last night. I will not repeat that reference except to say that it was extremely generous but helpful to meeting the target that from October 2009 child benefit will be disregarded in calculating income for housing and council tax benefit. I applaud that as I did last night.
	The Chancellor also wants to be innovative in the approach to increasing parental employment and raising incomes and is initiating pilots to look for solutions to the problem. Pilots are all very well when one has no idea what might happen, but in this case there is an existing formulation. There is no need to reinvent the wheel. The Government already subcontract job finding for difficult-to-place people from job centres to charities, which is having some success in places such as Brixham, for example. The problem is though that these contracts are not long enough and are paid for in rather strange lumps. In a debate some time ago the Minister said that he would look into this and come back to me. It may be that my memory is at fault, but I cannot recall him ever doing so. I do not want to dilate, like the noble Lord, Lord Oakeshott, on the fallout from the Welfare Reform Bill, but I will happily repeat, as I said several times during consideration of that Bill, that it was a sensible and well intentioned measure, because work is certainly the best way that I know out of impoverishment.
	Returning to the wider aspects of this debate, there is much more that could and should be done to take people out of poverty. The risk has hardly changed since 1997 for children in two-parent families, and actually rose last year from 21 per cent to 23 per cent. The Government should take responsibility for that and propose solutions. Even worse, poverty among working-age adults rose by some 700,000 last year to 7.2 million and has risen overall since 1997. What are the Government doing to address that horrendous situation?
	Unless the Minister wishes to dispute my figures, he and I—at least, I hope that it is he and I, not just I—await this year's report, Households Below Average Income, which should have come out in March, but was subsequently due to come out last Thursday—presumably because it would be a good day to bury bad news. Ministers in another place have now told my honourable friends that the statistics will not come out until June. Why, for goodness' sake?
	Unlike the noble Lord, Lord Oakeshott, I believe that the answer to poverty lies at the input end of the equation, rather than the output end. I agree with the right reverend Prelate the Bishop of Liverpool that much of this should be tackled locally, but it is the Government who set the parameters most of the time for local activity. Why is it, for example, that parenting skills are getting less and less from generation to generation? I am all for teaching parenting in schools, but on the evidence that I have, which I admit is flimsy, it is not yet working. I am sure that other noble Lords with better knowledge of education than mine would be able to correct me if I am wrong.
	What are the Government doing to raise the aspirations of young people? I agree with the noble Lord, Lord Haskell, that they should recognise that educational failure begins at an early age. Teaching reading using synthetic phonics in the past helped all children to read more quickly and helped those from poorer backgrounds most of all—closing the attainment gap. But that method has largely disappeared. Teaching should encompass standards, literacy, reading, mathematics and, above all, discipline. Here, government diktat means that teachers are trying to operate in handcuffs. This must stop.
	I think that the Government approve of new academies but are a little blinkered on them. Academies ought to be financed and run not only by philanthropists and teachers, but by educational charities, companies, even trade unions and parents—and they should be open to all within the system. The academies should be targeted at the poorest pupils through a pupil premium. That is done in schools like Millfield, so why should it not be done in the state sector?
	Even the pupil most unconnected with education has a small spark of interest in something—it may be games, computers, racing cars or even my favourite subject, bridge. I do not know and it does not matter. Education should bring such interests to the fore, otherwise teachers are just trying unsuccessfully to cram facts into children, which I like to call "inducation".
	Why not make sure that prisoners are better educated? I do not know the figures, but a lot of people in prison are illiterate and know no simple maths. Why not make the Prison Service responsible for reducing the rate of prisoners' reoffending? Why not bring the two stages of prison and probation closer together? Should not the market in offender management be available to many more organisations outside the state sector? At the end of the day, however, people need money to survive, and state money should be a temporary leg-up, not a long-term support service—except, of course, for the severely disabled.
	We need to tackle the high cost of credit in the doorstep lending sector. One way of doing that would be by teaching financial literacy to all 11 to 18 year-olds. As the Financial Services Authority has found, the average person could gain up to £700 a year by making better financial decisions. It goes without saying that this would have a disproportionate effect on the poorest in society.
	I have a dream, which I hope can be fulfilled in my lifetime. Every time a salesman says, "Of course you can afford it, it is only 5 per cent", the automatic response is, "Yes, but what is the APR?", and the person who asks that question understands the answer. I should also like to see credit card companies giving much clearer information to the public about the cost of credit card debt.
	We all know that bad health and poverty go together. The Minister should talk to his noble friend Lord Darzi about his proposal for super-sized GPs' surgeries. Does this not mean fewer surgeries overall, and how will that help?
	I conclude that, although there is much more to tackling poverty than the world of work, the noble Lord, Lord Bilston, has done the House a great service by raising the subject this afternoon.

Lord McKenzie of Luton: My Lords, I congratulate my noble friend Lord Bilston on securing this important debate and thank him for his thoughtful and powerful speech, particularly concerning the importance of work and—in his terminology—the "poverty of the spirit" created by unemployment. I welcome the chance to set out the Government's impressive record in tackling poverty, because, over the past 11 years and across every measure, we have helped millions out of poverty.
	Tackling poverty is at the heart of the Labour mantra and of this Government's strategy. From Keir Hardie to Clem Attlee and on to Tony Blair and Gordon Brown, the Labour Party has championed the cause of the poor: challenging the notion that poverty is a symptom of birth or breeding; helping everyone to realise their talents; and encouraging social mobility and opportunity for all. As my noble friend Lord Haskel said, this is the cause that called many of us to politics. In order to create a fair and inclusive society and achieve social justice for all, we must—and we will—continue to help the poorest and improve their life chances.
	In tackling poverty, we seek to tackle more than material poverty. Poverty brings with it a collection of disadvantages that affect life chances. Poverty can stunt aspirations, with today's poor children too likely to become tomorrow's poor adults. It can limit educational chances and restrict health and happiness. Areas of deprivation can foster crime, drug abuse and fear—keeping local communities apart and preventing people feeling safe. Poverty is not acceptable and, under this Government, is not inevitable. In the past decade, we have made great strides forward. We have a solid platform to build on, but there is more to do.
	I say in particular to the noble Lord, Lord Skelmersdale, that this is in stark contrast to the previous Tory Administration. Poverty rose dramatically under 18 years of Conservative rule. By 1997, child poverty had doubled. Unemployment during those 18 years reached more than 3 million, and millions of poor pensioners were left to survive on less than £69 a week. Had we simply uprated the tax and benefit system that we inherited, there might have been 1.7 million more children living in poverty than there are today.
	We have reversed this record, setting ambitious goals and taking action to reduce and even eradicate poverty. We are taking radical action to eradicate child poverty by 2020, with tax credits and support for parents helping children out of poverty. Employment is up by 3 million since 1997; we have the highest employment in this country's history. Targeted support has lifted more than 1 million pensioners out of relative poverty and today no pensioner should live on less than £124 a week. For the first time in this country's history, we can look forward with greater confidence to securing full employment, eradicating child poverty and delivering justice to pensioners.
	I pick up the point made by the noble Lord, Lord Skelmersdale—we have heard it before from the Conservatives—about people in severe poverty, defined as 40 per cent of median household income. As he is well aware, the national statistics caveat data on this category. The Child Poverty Action Group has said that the figures are dodgy, as indeed has the IFS. It is not a sensible base on which to measure poverty.
	Over a decade ago, the UK had the highest child poverty rate in the industrialised world. More than one in four children lived in poverty. By pledging to eradicate child poverty by 2020, we have set one of the most ambitious policy objectives of any Government in the world. So far, we have lifted 600,000 children out of poverty, and we remain committed to the target of halving child poverty by 2010 on the way to eradicating it by 2020.
	Our strategy focuses on four areas: targeting benefits at the poorest; supporting parents into work; ensuring that communities are safe, sustainable places where families can thrive; and improving the life chances of poor children. Tax credits currently benefit 6 million families and 10 million children. Since 1997, we have invested more than £21 billion in child care services, and this year the Chancellor announced an extra £950 million to tackle child poverty. These are all measures that have helped to reduce child poverty and they show that even in today's tight fiscal environment, eliminating child poverty remains our priority. Tackling child poverty is not an easy task, but it is the right thing to do. It is a moral imperative that we break the intergenerational cycles that see children born poor and grow up poor, and then see their own children denied the chance to fulfil their potential.
	We know that work is the best route out of poverty, and the Government are committed to supporting people in finding work, staying in work and progressing so that they can build a sustainable future for themselves and their families. It is important that we remain committed to this if we are to meet the aspiration of 80 per cent employment, to which my noble friend Lord Bilston referred. As he said, today more people are in work than ever before—29.5 million from the latest figures. That is up 456,000 over the past year and is the second highest employment rate in the G7.
	The claimant unemployment rate of 2.5 per cent is the lowest since April 1975. Since 1997, employment is up by nearly 3 million. It is up in every region and every country of the UK; it is up in the neighbourhoods and cities neglected by the party opposite; it is up for disadvantaged groups, with 300,000 more lone parents in work—1 million are now in work for the first time ever—and 900,000 more disabled people in work. There are 1 million more people in work from ethnic minorities and 1.5 million more older workers in work. The number of job vacancies remains at over 670,000.
	All that did not happen by chance; it happened because we took the right decisions about the fiscal and monetary framework on which our economic stability is founded and the sometimes painful decision to eschew faster progress in order to secure sustainability in the funding of our public services in the long run. My noble friend Lord Haskel stressed the importance of getting the economy right and embracing globalism, rather than wishing that it would simply go away. It also happened because we put in place active programmes to help individuals to move towards and into the labour market. More than 1.85 million people have been helped into work through the New Deal programmes. Building on their success, the introduction of the flexible New Deal will establish a new unified approach to all jobseekers, whatever their age, skills or barriers to work. A key component of this approach will be skills screening and the opportunity for jobseekers to access work-related skills training. In short, there will be flexible, individually tailored support to ensure that no one is left out and no one is written off.
	We want disabled people to be able to make the same seamless transition from school to continuing education, training and employment as their non-disabled peers. Work Preparation, Workstep, Access to Work and Pathways are just some of the DWP programmes helping people into work. I saw that at first hand in Norwich just last week. I spoke to a woman who had been out of the job market for 15 years. She had been trapped in her home because of a fear that people with mobile phones were spying on her. With support from one of our third sector providers and funding from Access to Work, she is now in employment. She is gaining promotion in that job and her life is immeasurably better.
	These things are happening up and down our country in a quiet and unreported way, day in and day out. Frankly, they would not have happened before this Government came to office. They happened because we are helping to make work pay through the national minimum wage, the working tax credit and the upcoming "better off in work" credit. I acknowledge that we have more to do in helping benefit claimants understand, but under the current tax and benefit system there are very few circumstances in which an individual receives less money from earnings and in-work financial support than they would receive in out-of-work benefits.
	Although our record demonstrates that we are the party of opportunity and aspiration for all, we are not complacent. We will continue to ensure that we have an enabling welfare state, one that provides the opportunity to get back into the labour market and contribute to society and the security of an essential safety net for those who have fallen on hard times. Our goal is a welfare state that is a way out of worklessness and a way up the career ladder but not a way of life. We are extending, modernising and personalising the support we offer. However, there is a condition. We do not apologise for it, and I would not characterise it as the noble Lord, Lord Oakeshott, did. In return for providing employment skills and financial support, we expect more of those who can work to look for work and to train for it.
	Achieving full employment depends not only on a sound economy and willing and trained employees but on the engagement of employers. Local employment partnerships will ensure that disadvantaged customers get the right training and support so they can stay in work and progress their careers, benefiting themselves and their employers. Through these partnerships we aim to see 250,000 more people in work by 2010.
	My noble friend Lord Haskel referred to the work of OneNottingham, which I think is part of the cities strategies. I have had the chance to see some of the enlightened work going on there. We also heard from the right reverend Prelate the Bishop of Liverpool about his experience in local regeneration schemes. We believe that the approach of the cities strategies—which should involve all stakeholders, including the business community, local councils, Jobcentre Plus and others— ensures that the community is at the heart of these arrangements. That is crucial to their success.
	There has been a reduction of people on incapacity benefit. We are, as the noble Lord is aware, replacing it with the employment and support allowance so that the emphasis is not on what somebody cannot do but on what they can do. That is a very important change. There is increasing recognition that work, good work, is not only the best route out of poverty but good for health and individual self-esteem. Part of the challenge is therefore to secure safe and healthy workplaces to prevent individuals falling out of work in the first place.
	The noble Lord went on to talk about the employment and support allowance, which we will soon have the opportunity to debate fully. Again, I would not accept his analysis of the situation. There will be engagement with those in the work-related support group so that they will, we hope, access the labour market before they have been on the benefit a year. For people in the support group for whom that conditionality is not present, they will be either £3.15 a week better off or, for some, £15.75 a week better off in comparison to their position on incapacity benefit. We are expecting to be paying out in total nearly £400 million more in benefits over the next five years of the employment and support allowance compared to the existing incapacity benefit arrangements.
	I think I have dealt with the issue of Liverpool and the city strategy. The noble Lord, Lord Skelmersdale, commented on short-term contracts to charities in Brixton. In February 2008 we set out our commissioning strategy for the delivery of employment programmes which will see us moving towards longer contracts and payments tied more closely to outcomes. That seems to me exactly the right thing to do.
	The noble Lord asked about the release of the statistics on households below average income. My right honourable friend James Purnell set this out in a Statement a while ago. I think that a small flaw was identified in one of the statistics, which are independent of the Government. That is why further work needs to be done. The hope is that these statistics will now be released in June.
	We have not talked much this afternoon about pensioners, as our focus has been mainly on work. However, we are also delivering justice for pensioners, because we want all pensioners to have a decent and secure income in retirement and to share fairly in the rising prosperity of the country. Since 1997, pensioner incomes have risen across the board, with the poorest benefiting the most. Today, for the first time in a period of sustained economic growth, pensioners are less likely to be living in poverty than the population as a whole. We have focused help on the poorest pensioners and the poorest third are £2,100 a year better off. As a result, pensioner poverty has reduced by over a third since 1997, which means more than a million fewer pensioners living in poverty.
	The key to that has been the introduction of pension credit, one of the most radical changes to income-related benefits for older people in 50 years. It ensures that no pensioner need live on less than £124 a week and it supports pensioners with savings, second pensions and earnings. Maximising take-up is crucial to tackling poverty levels, which is why we have simplified the claims process, although more needs to be done to ensure that that benefit is fully accessed by those who are entitled to it.
	We should not forget free TV licences for the over-75s, free off-peak bus travel, free sight tests and the winter fuel payment. We recognise that rising fuel prices, driven by rising world demand, can have a disproportionate impact on older people, which is why this year the Chancellor announced that older people would receive an extra one-off payment to sit alongside the winter fuel payment. Households with someone over 60 will receive an extra £50 and those with someone over 80 will receive an extra £100. This significant extra support will help more than 8.5 million households or nearly 12 million people. It will ensure that the winter fuel payment continues to provide a significant contribution to winter fuel bills.
	Our support is not only through this payment. Energy efficiency programmes, including Warm Front, target fuel-poor households in need of loft or cavity wall insulation, helping to reduce their fuel bills as well as generating carbon savings. Moreover, we have worked with energy suppliers on voluntary agreements, which will mean that the total assistance offered to vulnerable households increases to £150 million a year by 2011.
	We are making the biggest reforms in UK pensions in 100 years. For the pensioners of tomorrow, we are reforming the state pension and, in private pensions, our reforms will ensure that everyone can save for a better retirement. These changes will create equality for women and carers in state pension provision within half a generation. We will re-establish the link between the basic state pension and earnings during the next Parliament; our objective is to do it in 2012. We have already reformed SERPS, now S2P, which significantly improves coverage for lower-paid workers and people with parenting and caring responsibilities, typically women. Currently around 2.1 million carers, more than 90 per cent of whom are women, and around 6.1 million low earners, almost 60 per cent of whom are women, are accruing entitlement to S2P. Around 1 million more people will accrue S2P from 2010, approximately 90 per cent of whom will be women. We will pay for this by gradually increasing the state pension age to 68 by 2046.
	Private pensions will give all workers the opportunity to save in a pension, encouraged by auto-enrolment by employers. By 2015, this will see up to 9 million people saving more or for the first time and around £10 billion more being saved in pensions.
	The past decade has witnessed rising numbers of people in jobs and rising prosperity across the whole of the UK.

Lord Oakeshott of Seagrove Bay: My Lords, before the noble Lord sits down, perhaps he could deal with the main thrust of my remarks—which I do not think he did—which was that the most deprived regions and constituencies have not shared fairly in the growing prosperity that we all accept has occurred in this country over the past 11 years. If he does not have time to do that now, will he undertake to look into it and write to me?

Lord McKenzie of Luton: My Lords, I am very happy to write to the noble Lord on that, but employment has increased not only right across the country, but in every region and every country in the UK. The noble Lord shakes his head. I will write to him just to reinforce that.
	We have achieved a lot, but we know that there is still more to do. The Government's policies are about championing social justice and defeating inequality. We will continue to increase support for those most in need, to help people into work and to improve life chances. We want to ensure that poverty is not a way of life, so that we can continue to build a society based on fairness and on opportunity.

Lord Skelmersdale: My Lords, before the noble Lord finally sits down, he was good enough to agree with me about the number of children whom the Government have lifted out of poverty. He gave the figure of 600,000—exactly as I did. As I pointed out, yesterday at Prime Minister's Questions, the Prime Minister said that the Government have,
	"taken a million children out of poverty".—[Official Report, Commons, 7/8/08; col. 698.]
	I checked that in the House of Commons Hansard this morning. Clearly, the noble Lord will not have an answer now, but I should be very grateful if he would write to me to tell me how he rationalises those two statements.

Lord McKenzie of Luton: My Lords, I was probably doing my preparation for Report of the Child Maintenance and Other Payments Bill when Prime Minister's Question Time was on yesterday, but I will certainly look into the matter and ensure that the noble Lord gets a note on it.

Lord Bilston: My Lords, I express my sincere thanks to all the participants in this very important debate. I thank my noble friend because he has confirmed, as I said in my speech, my faith and support for our Government and what they have achieved in tackling the major issues of poverty and improving our society in the way that they have in the past 11 years. I thank him for enumerating all those wonderful policies that are reaching out to the people that we seek to be uplifted from the poverty and deprivation that they face.
	To the noble Lords, Lord Oakeshott and Lord Skelmersdale, I say that further evidence is here in this debate that we are all committed to the elimination of poverty, to the social justice that flows from it, to the need for this society of ours to create the conditions where people are—as I said in my speech—more equal and wealth is more equally shared.
	We should continue to debate these issues, because it is work in progress. No party can claim that it has reached the success that we want to reach for those millions of people in poverty.
	"Ah Love! could thou and I with Fate conspire
	To grasp this sorry Scheme of Things entire,
	Would we not shatter it to bits—and then
	Re-mould it nearer to the Heart's Desire!".
	I beg leave to withdraw the Motion for Papers.

Motion for Papers, by leave, withdrawn.

Health: Allergy (Science and Technology Committee Report)

Baroness Finlay of Llandaff: rose to move to move, That this House takes note of the report of the Science and Technology Committee on allergy (6th Report, Session 2006-07, HL Paper 166).

Baroness Finlay of Llandaff: My Lords, it has been a great privilege to chair the committee and to introduce the debate today. The members of the committee who conducted this inquiry were notable for their enthusiasm and commitment to the subject. I know that they would wish to join me in expressing our great gratitude to our hard-working Clerk, Sarah Jones, and our wise specialist adviser, Professor Barry Kay, as well as to all who gave evidence to us, informed our seminars or hosted our visits in the UK and abroad.
	The report and its recommendations have been warmly received in the allergy community by professionals and patients alike and extensively covered in the media. Several authoritative reviews of clinical allergy services preceded our report, and all of them noted serious deficiencies. Against this backdrop, we set out to look at the wider social and economic implications of allergy. Yet as the inquiry developed, it became shockingly apparent just how severely allergic diseases could impair people's quality of life and how, despite our track record of high-quality research in the field, allergy services in the UK lag far behind those of other European countries through a severe shortage of allergy specialists.
	During our inquiry, we heard of children with allergies who sleep poorly by night and are bullied at school by day, and whose hay fever impairs their performance in summer exams. We learnt that the workplace environment can cause or so exacerbate allergic symptoms that some adults are forced to give up work. Yet there is no clear guidance about what to do next or how to control their symptoms. We heard of fatal anaphylaxis, particularly through insect stings and food allergies. We found that we could not quantify the problem, the full health costs of allergies or the economic burden to society, because the reporting systems in the NHS do not code specifically for allergy per se. We did discover, however, that prescriptions for allergy symptoms cost nearly £1 billion a year—about 11 per cent of the total community drugs budget.
	We made many recommendations in the report, some of which are key to improving the situation rapidly for sufferers. The bulk of the key recommendations concerns the woeful deficit of clinical allergy services in the UK—a deficit already severely criticised in reports that preceded ours and for which the Government presented no convincing remedial plan in evidence to us.
	Other key recommendations were: the urgent need for the education of healthcare professionals about allergy and of those in catering about handling food allergens; the importance of research into the causes and factors that exacerbate allergy, as well as ways in which to prevent allergies, particularly peanut allergy, from developing in the first place; the adoption of immunotherapy in treatment in the UK, because it is not happening yet; and better support in schools for children with hay fever and other allergies. Without implementation of these key recommendations, our other recommendations on monitoring allergy, air pollution, occupational rehabilitation, advice to parents and the urgent need to evaluate complementary therapies and diagnostic kits would have relatively little effect.
	There are only 26.5 whole time-equivalent allergy specialists, many of whom are clinicians funded through research rather than the NHS, compared with several hundred specialists in some European countries. Of the 94 allergy clinics in England, only six are led by a full-time allergist. The others are uni-disciplinary clinics, which are held a couple of times a week and led by organ-specific specialists working in relative isolation. Pitifully few services of any sort are available in the north and west.
	The lack of allergy-service infrastructure is mirrored by a serious lack of allergy knowledge amongst clinicians at all levels, particularly in primary care. Even when a GP recognises that a patient needs to be referred, it is hard to identify who to refer to, and some patients resort to attempting self-diagnosis using inappropriate and unproven tests. Furthermore, the answer to better diagnosis in primary care is not pedalling diagnostic kits, but education, education, education, because misleading false positives abound without an accurate history and a proper clinical examination.
	We saw a very different picture in Denmark, where the various specialists work collaboratively to provide an efficient diagnostic and management service for patients. With the financial constraints of the NHS, we accept that it would be unrealistic to call for the immediate training of hundreds of dedicated allergists, but we do feel that more need to enter training. However, we suggest the harnessing of the pockets of allergy expertise that already exist by clustering the various specialists to work together in designated allergy centres. This would not require a vast amount of additional funding and could be implemented quickly. At least one allergy centre led by a full-time allergy specialist should be established in each strategic health authority area, bringing together those who already have a special interest in allergy: from chest medicine, dermatology, occupational medicine, ENT, paediatrics, clinical immunology and gastroenterology, with support from specialist nurses and dieticians.
	Each centre of excellence would form a hub where clinicians working together would learn from each other and provide expertise to investigate and diagnose complex allergies and guide management plans. They would also guide management plans as the patient goes back to their GP for their care to be monitored in an ongoing way. In a hub and spokes model, the centre could also provide outreach clinical services across their region and be a single point of contact and co-ordination, especially for those patients with complex, multi-system allergic disease, and for other clinicians with a special interest in allergy. The centre would provide outreach education to both primary and secondary care. It would also be a resource for patients, so that feedback between patients and the centre would guide development and disseminate new research evidence. The centre itself would then foster research, particularly engaging the patient's voice in research development within its area.
	In their response, the Government reverted to their well-worn argument that responsibility in a devolved NHS rests with local commissioners, but acknowledged that our suggestion merited careful consideration. Since publication, I have met the Minister, Ann Keen, and the Minister in this House, the noble Lord, Lord Darzi, both of whom expressed their enthusiasm for such a pilot project. Moreover, Professor Custovic from Manchester has informed me of a prime opportunity in the north-west where a framework and business case for just such an allergy service has been developed and locally endorsed by the specialised commissioning group, but the only thing holding it up has been funding. So I look forward with great anticipation to hearing from the Minister about progress made by departmental officials who were going to explore this with stakeholders, and I hope that he will have a positive response to announce today. I am grateful to him for his work and for his recognition of the importance of developing a pilot centre. We on the committee see the clustering of expertise in allergy centres as the most important way of ensuring that the other changes are championed and followed up in order to improve the health of millions of people suffering from allergic diseases in the current allergy epidemic.
	I turn to therapy. Although we were not investigating appropriate ways to diagnose and treat allergic conditions, the argument to support immunotherapy in order to desensitise patients suffering from hay fever and venom anaphylaxis became evident. In Germany and Denmark we saw the efficacy of immunotherapy and realised why we had been told that the NHS is the laughing stock of Europe for its absence of immunotherapy for allergic diseases. We are puzzled that new immunotherapy products are licensed in the European Union, but the MRHA has not approved them in the UK. It is also disappointing that NICE has told us that there are no plans to carry out an appraisal of this type of treatment for allergy sufferers.
	Prevention is certainly better than cure. Excellent research, largely from the UK, has elucidated allergic mechanisms and genetic susceptibility, but the way the immune system develops in infancy on exposure to allergens remains poorly understood. Environmental factors which can exacerbate allergies, such as dust mites and damp housing, have been implicated in the genesis of allergy. But, as was pointed out to us, everyone lived in damp, cold housing 100 years ago and there was much less allergy. Even the hygiene hypothesis which has featured a lot in the press, we discovered, may be somewhat inconclusive. So we recommended that long-term cohort studies warrant support to explore the effect of environment on the inception, prevention or exacerbation of allergies.
	School poses particular hazards for children with allergies. Eczema is itchy and disfiguring and treatment creams are potentially stigmatising. Hay fever sufferers under-perform in summer examinations, dropping a grade compared with their winter mocks at times, and support varies widely between schools. For food allergic children, casual contact with food allergens can precipitate fatal anaphylaxis. Some suffer terrible bullying when other children put nuts into their pockets or lunchboxes to try to contaminate their food, yet school staff do not necessarily know how to deal with anaphylactic emergencies. That is why we called for a review of the care of hay fever sufferers, particularly schoolchildren during exams, for approved allergy training of staff and a review of the case for schools holding generic adrenaline auto-injectors.
	So why did the Government brush these aside quite so dismissively? Hospital admissions for anaphylactic shock rose sevenfold from 1990 to 2004 but the true number of deaths remains unknown. Potentially fatal anaphylaxis can occur anywhere and probably a fair number of drug reactions are actually allergic reactions to the medication given. For people with food allergy, eating out is particularly hazardous and food shopping presents a minefield because food labels are inconsistent, confusing and offensive, with warnings so overused that teenagers tend to ignore them. So we recommended greater accuracy on food labels to clearly specify known allergens in the product.
	Almost 26,000 people in England have known peanut allergy and yet, on one of our visits to the Evelina children's hospital, we learnt that in countries such as Israel peanut in weaning foods seems associated with low rates of peanut allergy. This evidence has inspired Professor Lack's study. His hypothesis is that the avoidance of peanuts during pregnancy and infancy may be contributing to the epidemic. That led us to recommend the Department of Health to withdraw its out-of-date advice on peanut consumption. No other Government advise peanut avoidance in pregnancy. I ask the Minister when the review commissioned from the Food Standards Agency and the Committee on Toxicity will be available. I understand that those bodies have been charged with reviewing the subject.
	About one-third of the population will develop symptoms due to allergy at some time, and these are not trivial problems. Today's debate is particularly timely as the seasonal problems of hay fever, insect stings and plaque dermatitis resurge to join the perennial food and other allergies. I have been able to cover only the areas that the committee felt required the most urgent action, particularly the need to cluster expertise together to form centres of clinical excellence. Many groups are anxious to see the report's recommendations implemented. The allergy epidemic continues and people are demanding better clinical services, reliable advice on food and better support at school for children with allergies. We hope the Minister shares our vision to improve allergy services. I am sure that he recognises the enormous public interest in the subject and I look forward—as does the committee—to his responses today. I beg to move.
	Moved, That this House takes note of the Report of the Science and Technology Committee on Allergy. 6th Report, Session 2006-07, HL Paper 166.—(Baroness Finlay of Llandaff.)

Lord Haskel: My Lords, I put on record my appreciation for the work of our clerk, our special adviser, my colleagues and our chair. It has been a wonderful experience to work with them. It is sometimes quite daunting to be a member of your Lordships' Committee on Science and Technology. There are many eminent and highly qualified people serving on the committee. Participating in this debate are eminent physicians who are experienced in diagnosing allergies; eminent scientists who know all about the little that is known about allergies; and people who, unfortunately, suffer from allergies. They are all well qualified to speak. Of course, there is the Minister, himself highly qualified.
	What are my qualifications? My qualification is that I am a strong supporter of this Government and wish them well. More than ever, I am anxious that they should keep in touch with the public, address people's concern and, as they say, be a listening Government. Working on this inquiry, one thing came across loud and clear: people are concerned about allergy. Every time I told friends about our inquiry, inevitably they would respond with an account of their experience of allergy or that of a family member. My children are young parents, and they responded with concerns about their children. Every few days somebody would bring to my attention media items about allergy. There was a supplement last Sunday, mentioning our report and, indeed, the noble Baroness, Lady Finlay. As the Minister knows, the media make it their business to reflect people's concerns. Teenagers tell me that allergies are now a topic appearing in the social networking sites. The concern seems to be that allergies are a feature of modern life. The noble Baroness, Lady Finlay, spoke about there being fewer allergies 100 years ago. As we raise our standards of living, so, apparently, allergies increase. It would appear that they are not going to go away.
	The noble Baroness spoke about regular warnings. Yes, the Royal College of Physicians reported in 2003; the House of Commons reported in 2004; the Department of Health itself reviewed the services for allergies in 2006; and your Lordships reported in 2007. All showed concern. I do not know about the other reports but I can confidently tell the Minister that the British public listen to House of Lords reports. How do I know? I have the privilege of being a member of the Lord Speaker's outreach team. I have also moderated young people's debates. Invariably, people tell me how much they value your Lordships' reports for their authority and impartiality. This is why I ask the Minister to listen more carefully to our report. The public are certainly listening to it. One day the Minister may have to explain why it was ignored.
	It is not going to go away. This year there have been letters in the Times, one from medical experts and one from the public, represented by the Surrey Women's Institute. As we know, you ignore the Women's Institute at your peril. I am not suggesting that the Minister jumps on a passing bandwagon. That activity is reserved for the Opposition. I am suggesting that the Government should listen and hear. If they do not, others will, and the public will want to know why.
	There is another reason why the Government should listen: money. As the noble Baroness, Lady Finlay, explained, nobody really knows what allergy costs the economy. As we explained in our report, this is all to do with record-keeping. There are a number of straws in the wind which indicate that the amount could be substantial. For instance, the Royal College of Physicians states in its report that contact dermatitis accounts for half of all days lost from work through sickness. That in itself would amount to an awful lot of money. There are indications that one in five of the UK population suffers from hay fever. That must be a considerable cost to the economy, as well as effecting children's performance at school or during exams. The House of Commons has tried to put a number on this: it states that allergy accounts for primary care expenditure of £900 million a year.
	Although these costs may not be exact, they could be considerable—and when they relate to a matter of public concern, costs have a horrible habit of achieving major significance. So it will come as no surprise to the Minister that when I read the Government's response I was disappointed that they did not seem to share the concern of the public and the experts. Certainly, the response dealt with our recommendations; they were sent down the line for action and consideration in a most efficient manner. Any sign of shared concern with the public, however, was absent. Dealing with public concern is rarely a matter of administration. It involves political will.
	Perhaps we were at fault in addressing our concerns to the Department of Health. Allergy issues are much broader than that. The Government's response includes contributions from other departments: business, regulation, children and families, communities, local government, environment, food, work and pensions, health and safety. It is a very broad topic. That is why so many people are aware of it and why so many of them are concerned. Will the Minister look at this report again, not from the point of view of administration, but from the point of view of a Government who are in touch with the public, listen to their concerns and want to know what is being done by all those different parts of government to deal with those concerns? If the Government do not do that, it will come back to bite them.

The Earl of Selborne: My Lords, the whole House will be grateful to the noble Baroness, Lady Finlay, for introducing the debate with such authority and for having chaired the inquiry so skilfully. We all learnt a lot. Like the noble Lord, Lord Haskel, I do not feel myself as qualified as some of the great experts we have on the committee. I cannot say, however, that I feel I have the same qualifications to speak that he feels he has speaking from those Benches to urge the Government from behind, but I agree with him that this is an issue of concern for the wider public. The committee has articulated the concern that was apparent to me as a lay member.
	I shall deal with the research issues arising from this allergy epidemic. We have already heard that we have one of the highest prevalences of allergic diseases in the world. The costs for the National Health Service are rising. We have already heard what the figures might be, but let us just say that the direct cost to the NHS is around £1 billion while primary care prescribing costs are around 11 per cent of the total drugs budget. Something like 17 million working days have been lost due to asthma alone, at a cost of another £1 billion—you can just talk about round billions with these figures.
	The most startling thing of all for me—I say again that I start from a position of total ignorance on this subject—is that we do not seem to know why the incidence of allergy and allergic disease is rising. As the noble Lord, Lord Haskel, reminded us just now, it is clearly linked to some aspect of the more prosperous living conditions we have enjoyed since the 1960s. Dramatic increases were seen between 1964 and 1980, and there have been continuing increases since then. In Germany following reunification, and in other parts of Eastern Europe, there has been an increase in the incidence of allergic diseases right across the former Iron Curtain countries. It seems that there is a critical window of exposure in the first year of life during which the child's immune system can be influenced, and their risk of allergic disease substantially reduced. Yet once children pass their first birthday, the same factors that would have prevented them from becoming allergic no longer operate, implying that any intervention to change the prevalence of allergy would have to target that very early phase of life and not be brought in some five years later.
	There is still uncertainty on whether avoidance of specific allergens during pregnancy is desirable, or whether exposure to some allergies in appropriate contexts actually helps to protect children. A lack of research into the development of the immune system and the establishment of allergy means that the scientific community is still not able to answer fundamental questions, such as whether peanut avoidance protects the child from peanut allergy.
	To answer such questions, we need broader studies; as the noble Baroness, Lady Finlay, said, long-term cohort studies are required. Those are not easily funded and do not produce specific conclusions. As Dr Egner of the Royal College of Pathologists advised us,
	"In a competitive research environment, it is a brave person who goes into a messy area with no clear outcome".
	Professor Burney, who is a Professor of Respiratory Epidemiology and Public Health, said that it was a dilemma for those funding research to choose between good, basic science that will,
	"find the exact answer",
	And,
	"a more speculative bit of work that is going to advance general knowledge but is not going to give you the same kind of precise answers".
	The majority of research funding, from the research councils and other public funding streams, focuses on the basic allergy mechanisms; indeed, this research is strong in the United Kingdom. We have research groups that are world leaders in research into the underlying mechanisms of allergy and allergic diseases. High-quality research of that nature in this country has significantly advanced our understanding of the molecular mechanisms of allergy. Where we fall down is in funding, adequately, epidemiological research and research into the development of the immune system.
	Research in academia is hindered because of that separation between clinical work and the research centres. If the recommendations of our report help those specialist allergy centres it would certainly help enormously to bridge the gap, as it is difficult at present for the academic researcher to access patients' data from general practitioners. Indeed, those are sometimes impossible to obtain. Without access to a good, representative sample of the population at reasonable cost, epidemiological research is hamstrung.
	In supplementary evidence, recorded on page 60 of the second volume, Professor Burney explains how the patients' data are now regarded as confidential and access is denied—in marked contrast to such countries as Germany where data are more accessible. The professor said:
	"Under the current rules, because we cannot have access to the names and addresses until the patients have replied to say that they are willing to participate, we are unable to help with any of this process. For a busy general practice this is an all but impossible task and it is amazing that we have any volunteers".
	He went on to ask, not unreasonably, for permission to use names and addresses of patients registered with GPs, together with their dates of birth and gender, providing; first, that the programme of work—including the letter of invitation to participate and the questionnaire—had ethical committee approval and, secondly, that the staff were adequately trained and had honorary contracts with the health authority or trust. Professor Burney ended his letter to the committee,
	"The irony is that a properly designed and well vetted study to improve our knowledge of public health is forbidden, but any company can ring me up at home and conduct surveys or try and sell me whatever they please. If your committee were able to find a solution, this would be greatly and widely welcomed".
	We address this issue in paragraph 7.26, which states:
	"It is imperative that further research should focus on the environmental factors, such as early allergen exposure, which may contribute to the inception, prevention or exacerbation, of allergic disorders. Long-term cohort studies are a vital part of this research ... We look to the ... Office for Strategic Coordination of Health Research to improve the co-ordination and funding for these types of projects".
	The Office for Strategic Co-ordination of Health Research arose from the Cooksey review which addressed this issue, which has been a problem for so long that the Medical Research Council undertakes research into it, as does the National Health Service. But before the Cooksey review the two lacked co-ordination. This is a challenge, if ever there was one, for the new Office for Strategic Co-ordination to try to ensure that there can be an exchange of data and a seamless join between the two funding research streams.
	The Department of Health claims to be increasing its support for research into the environmental factors that contribute to allergic disorders. It would be encouraging if the Minister could add his support not just for increased funding but for putting in place improved co-ordination so that researchers can be granted adequate access to the relevant data that they ask for.

Lord May of Oxford: My Lords, this Select Committee report is particularly timely. Under the excellent chairmanship of the noble Baroness, Lady Finlay, it produced a thorough, thoughtful and constructive review of the rising incidence of allergies in the United Kingdom and, helped by its excellent secretariat and its specialist adviser, Professor Kay, produced a set of constructive and sensible recommendations. However, I found the Government's response disappointing in parts and in some cases dismissive.
	I strongly endorse the remarks made by all the previous speakers, particularly by my noble friend Lady Finlay in opening the debate, and join with the noble Lord, Lord Haskel, in asking for the report to be read again, recognising that it contains important comments expressed thoughtfully by a lot of well informed people.
	I wish to relate my next point to a somewhat wider area that the noble Earl, Lord Selborne, covered in detail and elaborate on the decision made nine years ago to recommend to women that they avoid eating peanuts when pregnant and avoid exposing their children to peanuts. I thought then that the advice was not well founded but I recognise that that was debatable at the time. I am given to making gestures in the Chamber as a substitute for using PowerPoint, but this time I shall not distribute my papers all over the Bench in front of me. Since then we have seen a linear rise in the incidence of peanut allergies. I understand as well as the next person that correlation is not causation. There is also the hygiene hypothesis—we have heard about this and I shall not elaborate on it further—that we live in an excessively hygienic environment and people's immune systems are more disposed to develop pathologies. I recognise that that is not proven, and even if it were, it would not necessarily conclude that eating peanuts was advisable. None the less, careful epidemiological studies show that in Israel, where infants are exposed to peanuts, there has been no corresponding rise in the incidence of peanut allergies. The rate is low and flat, whereas our incidence of such allergies has risen even with the advice I mentioned.
	In Africa, children are also commonly exposed to peanuts and have no allergies. There could be genetic differences. I realise none of those points amounts to a proof that you should tell people to rush out and expose children to peanuts, but in my mind they amount to a powerful argument for reviewing the advice not to. The Government's response to that particular recommendation was to say that they did not think it appropriate to withdraw the advice without having alternative advice to replace it. Fair enough, but I think the advice that ought to be given now, in the light of the additional facts we have gathered over those nine years, is that we do not understand this well enough to issue advice definitely one way or the other, but the indications are that there is no harm in eating peanuts.
	From my five years as chief scientist, I realise how uncomfortable Governments are with saying that they do not know, and yet the protocols for science advice in policy-making—issued under John Major in 1996, reviewed by myself under Blair in 2000 and further strengthened by my successor—say that you consult widely and openly, you review changing circumstance and you admit uncertainty. That, in fact, engenders confidence in the public.
	That leads me to my final brief point. The noble Earl, Lord Selborne, elaborated very cogently the other piece of evidence that receives generally less attention—namely, that research into the fundamental aspects of how the immune system first creates itself somatically in the first three years of life is difficult and not fashionable. On the molecular details of some of the actual allergies that have arisen, we are among the world leaders, but the world as a whole finds it unfashionable to look at this question. The immune system is not coded in the genome. What is coded in the genome is a programme to assemble itself. The conjecture is that if it is not appropriately sufficiently challenged, it goes looking for inappropriate work to do, hence a rise in allergies. Maybe that is right; maybe it is wrong.
	This requires a fusion of people who work on non-linear dynamical systems with people who do careful clinical epidemiological work. As we heard in the report, and as was emphasised by the previous speaker, one of our recommendations is that it receives more attention. If I were the Secretary of State for Health, I would bring together an informal group of people from research in the National Health Service, the Wellcome Trust and relevant research councils—because this is not just a Department of Health responsibility—to ask whether there may not be some kind of coalition that puts a little bit more effort into soliciting this kind of unfashionable, multi-disciplinary research, where the potential researchers have told us they are finding difficulty getting funding.

Baroness Perry of Southwark: My Lords, I, too, would like to pay tribute to the noble Baroness, Lady Finlay, both for opening this debate so expertly today and also for her chairmanship of the sub-committee. She has a degree of energy and expertise from which we were all able to benefit and she became a very close friend to every member of the sub-committee under her guidance. I recognise the splendid support that we had from our clerk, but would like to pay a particular tribute to our specialist adviser Professor Barry Kay, whose extensive knowledge and extremely experienced wealth of time in the field so greatly enhanced our work.
	I would like, in the brief time available today, to reflect on one aspect of our report—that is, the impact of allergy on children in school—and to highlight some of the problems and solutions which we proposed in our recommendations. As other speakers have commented, allergies can cause a very severe reduction in the quality of life for school children. Think for a moment about children with eczema. Ms Sarah Day, our witness from the Royal College of Nursing, spoke to us about the image problems of children with eczema, which can be deeply distressing to the child or young person, and can often lead to teasing and bullying from other children who do not understand the illness that causes the extraordinary appearance that many of them can exhibit.
	A survey by the Department of Dermatology at the Wales College of Medicine showed the devastating impact that severe eczema might have on the lives of children. Beyond the embarrassment, which for them is often the key part of the thing, there is also evidence of sleep disturbance and therefore impaired school performance. Think of children with severe asthma. They, too, suffer great underperformance in school, for many causes. Some 38 per cent of allergy sufferers had missed a considerable part of their schooling due to their asthma problems. Their sleep disturbance also made it hard for them to concentrate at school.
	Though less severe, the prevalence of hay fever among children also has a demonstrable effect on their performance, particularly in examinations. As we all know, GCSE and A-level examinations mainly fall in the peak hay fever season. A study of the impact of hay fever on exam performance by teenagers in the UK found that sufferers could drop a whole grade in their summer exams compared to the results of their mock examinations, which were taken in winter when their hay fever was not present. That drop in achievement can be caused both by the symptoms of hay fever and by the sedating antihistamines that are often given to them and which affect their long-term prospects, both of higher education and career development. This is not a small matter; children who may drop from a B to a C in their A-level results, for example, can fail to meet the offer that they have had from a university, and so miss out quite substantially on the university experience that they had planned for, and therefore be affected in their long-term future careers.
	Dr Paul Harrison, the director of the Institute of Environment and Health at Cranfield University, told us that children with asthma and allergic rhinitis often also opt out of sporting activities, so compounding their fitness problems. However, we received evidence that the awareness of the problems of hay fever sufferers and other allergy sufferers varied greatly, as did the way in which they were treated by their schools and local authorities. Some local authorities and schools allow special examination arrangements for sufferers, while others simply take no account of it at all. We recommended, therefore, that the Department for Children, Schools and Families should review the care given at school to hay fever sufferers and reassess the way in which they are supported during the exam season. Consistency of provision across schools and local authorities is a responsibility of the department; it is not enough simply to leave it to individual schools. We also feel very strongly that school nurses have a role in ensuring that children are not automatically given sedative antihistamines, which can impair their performance. I will return to school nurses in a moment or two.
	There are a small number of children whose allergies are even more life-threatening; children who are at risk of anaphylaxis, for example, a reaction to food such as nuts or to insect venom. The peanut allergy alone has increased dramatically in recent years, creating a real challenge for schools, where teachers may find themselves dealing with a life-threatening emergency of which they have absolutely no knowledge. The representative from what was then the Department for Education and Skills said rather dismissively that, "It is a head teacher's responsibility to ask themselves whether the cadre of teachers and support staff they have is able to deal with such an emergency". I do not think that is good enough. I say to the Minister that to leave it to a lay head teacher to make such an assessment is not a response that one would expect from a responsible government department.
	Children at risk from anaphylaxis usually carry an adrenalin auto-injector. We usually call them EpiPens, although I understand there are also AnaPens. Under current DCSF practice, only the EpiPen prescribed for the child is held in the school.
	However, many of our witnesses felt strongly that schools should keep a stock of those generic auto-injectors available, for example, for a child who may have forgotten their EpiPen on that particular day or one who needed a second dose. We recommend that there should be clear guidance regarding the administration of auto-injectors to children with anaphylactic shock in the school environment. We also recommend to the Government that they should review the case for schools holding one or two generic auto-injectors.
	Overall, however, we were concerned at evidence that allergies were poorly managed in the school environment. At the heart of this is the lack of training, most crucially for school nurses but also for teachers, support workers and heads themselves. That we felt was the heart of the problem. The evidence we would have given showed that there was a real problem in the training of school nurses. The department representative seemed to assume that school nurses were the answer to all the problems and could deal within the school with any emergency that arose and could also help with the training of the lay staff.
	However, the evidence we had from the Royal College of Nursing spoke of funding cuts and shortage of staff among school nurses. There is also a problem where some school nurses are employed by the school directly and others are employed by the PCT and therefore their training needs can be dealt with in different ways: particularly those employed directly by the school have no one competent to assess their training needs and little money made available for them to update themselves in allergy treatment.
	There is a lack of expert knowledge within the school system of how to deal with this huge problem. The Government document Managing Medicines in Schools and Early Years Settings suggested that every child who suffers from any form of problem that leads to them needing medication during the school day should have an individual healthcare plan. While we welcome that suggestion, we note that the heads have insufficient medical knowledge themselves to know whether their staff can deal not only with the routine medicines but with emergencies. We think it is simply not enough to leave it up to the school and to the head to draw up this individual healthcare plan and then to implement it.
	We believe that the responsibility lies with Government to ensure that a health professional is available to make the assessments and to provide training where necessary. In the current shortage of school nurses and the difficulty of funding for their training, we fear that this is unlikely to happen. Our recommendation therefore is that the department of children's schools and families should audit the level of allergy training that school staff receive and should take urgent remedial action to improve this training where it is required. The impact of allergies on school performance as the life chances of many young people is immense and far-reaching. It is therefore disappointing to find that, as with most of the sub-committee recommendations, the Government response was so half-hearted. While agreeing with the Committee's conclusions, no action was proposed, whether on the training required by staff, the storing of generic auto-injectors or the timing and arrangements of key examinations. It is not good enough. If, as we were told by our expert witnesses, allergy among children is of epidemic proportions and likely to grow, there is no excuse for us to stand back and leave it to lay people in schools and an overstretched school nursing service to deal with a national problem affecting thousands of children's lives.
	For me, the saddest comment that we heard from one of our continental experts on our visit was,
	"We are simply amazed at the contrast between the world-class quality of your UK allergy research and the dreadfully low quality of your UK provision to patients".

Lord Falconer of Thoroton: My Lords, before my noble friend Lord Bhattacharyya rises, I apologise to the noble Baroness, Lady Perry, for interrupting her excellent speech with my mobile telephone. I apologise to her and to the rest of the House.

Lord Bhattacharyya: My Lords, while I am no medical expert I am glad that this debate has been scheduled for today as I recently experienced serious allergy problems and can offer a layman's perspective on this excellent report. There is great interest in this debate and I believe that I know why. I was reading the committee's report this morning when my daughter asked me what I was doing. When I told her that I was going to speak on allergies she laughed and said, "Well, everyone is allergic to politicians".
	My own allergic experience was in line with the report's analysis. Last year, I noticed a rash on the left of my forehead which I assumed was an insect bite. As I often visit the tropics, one gets a lot of bites. However, within a fortnight a blister developed, so I went to my GP, who thought I had shingles. The treatment for shingles did not help and the lesion worsened. I was diagnosed with cellulitis and treated with intravenous penicillin, but the lesion did not fully heal. In addition, I developed a rash all over my body. My GP referred me to a consultant dermatologist who diagnosed me with an allergy, probably to the original insect bite. Penicillin was replaced by steroids and my skin improved. I then decided to get tests to find out what I was allergic to.
	I will not bore the House with the details of my treatment, but as Birmingham has only two immunologists, I went to a specialist London clinic to fully identify my allergies and have immunisation treatment. I was lucky to be diagnosed with an allergy relatively early on, but my case illustrates that a full diagnosis of allergies still requires a significant delay, private care, a lot of travel or all three.
	I want to be clear. I am proud of what the Government have achieved in the NHS. The West Midlands Strategic Health Authority under the leadership of Cynthia Bower has transformed the landscape of medical care in my region. We have made great strides in the past few years, with new hospitals and improved patient care. Wanting services to improve is not a criticism of the NHS. There should always be a debate about how public services should improve next. Allergy treatments currently have waiting times that are too high and a quality of diagnosis which is too low. As Dr Pumphrey of Research Councils UK stated,
	"patients are unlikely to get ideal advice from any but the best informed of specialist clinics".
	The Department of Health began its report on allergies with a summary of the problems. It said:
	"People can wait 3 to 9 months for an appointment to see a consultant in secondary care ... some may be passed around a number of different clinical departments for the different symptoms ... which can make diagnosis and optimal treatment difficult".
	I had no problems. I went to one clinic and very quickly all the experts were there and I was diagnosed early.
	The Government tell us that 81 per cent of GPs say NHS care for allergies is poor quality and only half of GPs are trained in managing allergic problems. My experience backs that up. These issues define the problem. Doctors do not have sufficient expertise to diagnose allergies and there are not enough specialists to treat the patients that are diagnosed. This means that patients who go to a GP with asthma have to attend seven times before they get a diagnosis, while only a third of those with asthma are given an allergy test. I was born in India, so I never had all the benefits of hygiene when I was young; therefore, I never had any allergy problems until I faced this one.
	Therefore, I endorse the conclusion that we need more training for GPs to diagnose allergies and an increase in clinical specialists based in a regional allergy centre. If we do not do that within the regions there are travel problems. I could afford private care, but the majority of people will have an enormous problem in accessing the sort of expertise that I experienced.
	We have strengths in allergy research and courses for diagnosis in the UK—for example, at Southampton and the medical school at my own University of Warwick. I am struck by paragraph 7.27 of the report, which states:
	"We are concerned that the knowledge gained from cellular and molecular research is not being translated into clinical practice. We therefore regard allergy research directly related to healthcare as an area of unmet need that requires greater priority".
	Perhaps we should kill two birds with one stone by combining the regional allergy centre with an existing training location. This would best relate allergy research to treatments and GP training.
	The Government are right to say in their response that,
	"Local need is what will determine how allergy services should be provided".
	We should not be recreating a "command and control" system in the NHS. I hope that Ministers also accept that local commissioners sometimes respond best to a strong lead from the centre. The Government have proved that successfully with waiting times. Launching the first regional allergy centre would be a strong lead from the centre. I welcome the Government's conclusion that a lead strategic health authority is a worthy idea and I urge action on it.
	We also need to help consumers by making it easier to detect any allergies that they might come into contact with. I now know what I am allergic to, both in chemicals and food—but it is a hell of a job to find out. When it comes to products such as aerosols, shampoos and detergents, one avoids all of them; because there is no clear labelling, one is scared.
	When you suffer from an allergy, you first look for a cure from those you trust. But if none is forthcoming, you look anywhere. If the NHS makes the correct diagnosis and identifies the right treatment, patients will not require the dubious remedies that have exercised the committee. If we ensure that labelling is clear to those who suffer from allergies, consumers will not be susceptible to the pedlars of snake oil.
	I hope that the Government respond constructively, so that we can make great strides in the treatment of allergies. Otherwise, we will see more patients fall into the arms of anyone who will offer them relief, no matter how far-fetched their claims.

Lord Taverne: My Lords, many speeches today have stressed the seriousness of what can be described justly as an epidemic of allergy. We learned in committee that, among six and seven year-olds, one in five of suffers from asthma. Some 5 million people suffer to some extent from allergy to grass pollen. There is some suggestion that the number of people affected by allergies is levelling out. However, there is no doubt that millions of people—possibly an increasing number—suffer severe impairment to their quality of life because of some form of allergy. It was therefore deeply depressing to discover how backward we are in the United Kingdom. No doubt there are centres of excellence, but the overall picture was described by the World Allergy Organisation Specialty and Training Council, which is quoted on page 89 of our report. It highlighted the paradox that in the United Kingdom, a country with an outstanding record in allergy research, there is a remarkably poor clinical service for allergy sufferers.
	I was disappointed that when the Committee pointed out how backward we were, the Government reaction seemed to lack the appropriate urgency—they seemed relaxed about our deficiencies. Yet, as our chairman stated, we are considered the laughing stock of Europe in this field. By the way, I add my tribute to the noble Baroness, Lady Finlay, for her chairmanship. In a previous committee on which we served—on physician-assisted dying—I found myself in profound opposition to her views. However, after learning more about her activities and, in particular, after experiencing her chairmanship of this committee, I have become an admirer and feel that she is one of the most valuable Members of this House.
	There are at least three respects in which we are backward compared with many of our European partners. The first is in training and education. The diagnosis and treatment of allergies is not part of the basic training of medical students—an astonishing situation. Nor are there adequate general clinical postgraduate courses in allergies for nurses and doctors, which is most important in the case of GPs. Most GPs are not properly equipped to diagnose allergies or recommend appropriate treatment.
	A second result of this inadequate training and education is that we have an appalling shortage of specialists. As the noble Baroness, Lady Finlay, pointed out, we have 26.5 specialists—I am not sure who is the half. Spain, with a much smaller population, has 1,300 specialists—50 times as many. Equally unfavourable comparisons can be made with Denmark, Germany, Sweden and many other European countries.
	One of the most damning comparisons concerns the very limited facilities we offer for immunotherapy. I quote figures given to committee members who visited Germany. They appear in the appendix to the committee's report, on page 128. Germany prescribes about 700,000 courses in specific immunotherapy, France about 500,000 and the UK about 5,000, yet the evidence that we received was quite clear. Immunotherapy is a standard and effective way of managing allergies in other European countries. It allows patients to lead much more normal lives, especially in the case of hay fever, asthma and allergies to wasp and bee stings, and it has a more lasting effect than treatment with drugs such as antihistamines or steroids. Immunotherapy can be administered either subcutaneously by injection, involving a lengthy and expensive form of treatment, or more cheaply and conveniently sublingually, by oral tablets. Sublingual treatment is very common in France but is almost unavailable in the United Kingdom. However, even the more expensive form of subcutaneous treatment saves costs in the end because it is much longer lasting and much more effective than drugs.
	Why do we neglect desensitisation or immunotherapy? We do so because the MHRA has created the strictest regulation in Europe. Its attitude seems to be determined by safety concerns based on 27 deaths from anaphylactic shock between 1956 and 1982—over a quarter of a century ago. A Danish company gave evidence that it had product licences for subcutaneous immunotherapy in many European countries but had given up seeking licences in Britain because of the attitude of the MHRA. We were also told that NICE has no plans to appraise immunotherapy products. However, the evidence that we received was clear. If administered by specialists in a proper environment, the treatment is safe. If there is a severe reaction, it can be promptly recognised and dealt with. The MHRA has simply not kept up with the evidence and it has apparently not looked at the experience of the rest of Europe.
	There is no justification for that defensive attitude. We seem to be unique in our view of the safety of the treatment. Not only other European countries but also the WHO regard immunotherapy as the most effective treatment—the only one that can influence the natural course of allergic disease. Its views are found at page 131.
	Therefore, I return to the question of why we are so backward and why we refuse to learn from the experience of other European countries. I fear that it is part of a wider disease—a certain insularity and a refusal to accept, because of insular attitudes, that in many ways other European countries are more civilised than we are. That is certainly the case in their approach to crime and penal policy but it is also the case in many aspects of health policy. Our National Health Service has many virtues and is often unfairly criticised, but our public attitude towards the scourge of allergy is, frankly, a national disgrace.

Lord Crickhowell: My Lords, the noble Baroness who initiated this debate and chaired the committee which produced this important report has, not for the first time, rendered a very considerable service to the House, to medicine and, above all, to those afflicted by illness.
	This allergy report was produced by the Science and Technology Committee before I joined it but, invited by the noble Baroness to participate in the debate, I said that I would speak of the experience of my own family and of the difficulty of finding general practitioners with the knowledge and time needed to provide the right diagnosis for a wide range of complaints. On reading the report, I found that the experience of my wife exactly bore out some of the most crucial evidence received by the committee and underlined the importance of some of its key recommendations.
	Going back to the early 1960s, after the birth of our first child, my wife felt the kind of pain all over her body that one suffers from a poisoned finger. Our unsympathetic GP said that it was probably postnatal depression and that she should see a psychiatrist. She was finally diagnosed by a patient and understanding doctor as suffering from an allergy to cow's milk. She consulted Professor Jonathan Brostoff, who gave evidence to the committee, one of the leading experts on food allergy and food intolerance. Some years later, after I had become an MP, she suffered from sores in her mouth, constant sore throats and swollen glands, was fed with antibiotics and told to lead a less stressful life. A wise doctor in Abergavenny, feeling sure that it was a food allergy, questioned her closely and suggested that it might be tomatoes. He was right. A long time later, suffering muscle weakness and aching joints, she finally found that she was suffering from an allergy to wheat. Today, when vineyards and wine companies are speeding up the maturing process of wines by adding sulphites, my wife has joined many others unable to drink wine.
	Talking to friends about these experiences I have often referred to the doctors who did come up with answers as being members of an increasingly rare breed, the first class diagnostic physician with the knowledge and time to come up with the right diagnosis. The committee, in Chapter 9 of the report, identifies the poor clinical service provided for allergy sufferers in this country. It quotes the 2004 report of the House of Commons Select Committee on Health which said:
	"Those working in primary care lack the training, expertise and incentives to deliver services ... Many of the deficiencies in primary care are matched by weaknesses in secondary and tertiary care".
	The Commons committee recommended that the GP curriculum should include allergy training and that specialist allergy clinics should be developed across the country as centres of good practice for the training of primary care staff.
	The report we are debating today reveals a shocking state of affairs. It is astonishing that it should be necessary for parliamentary committees to suggest that allergy training for GPs should be necessary. It is disturbing that witnesses report that the knowledge of allergy in primary care is poor and refer to minimal training. As if that was not bad enough we are told that there is a shortage of allergy consultants—and of expertise among consultants to whom GPs are likely to turn.
	On a visit to the allergy clinic at Addenbrooke's Hospital, committee members were told that it was a struggle to convince local commissioners to invest in allergy training and services because allergy was not yet recognised as an important subject.
	Allergy UK, a leading allergy charity, reported that for patients,
	"the major problem is the lack of knowledge at primary care level. GPs do not recognise allergic symptoms when presented with them due to a lack of training in allergy".
	A consultant allergist at the Royal National Throat, Nose and Ear Hospital told the Committee that:
	"'In medical schools the amount of allergy training is absolutely minute, if it exists at all'".
	Another doctor, making the same point, went on to say that when it comes to postgraduate training,
	"'there are so few allergy specialists in the country, there is no one to undertake teaching'".
	Paragraphs 9.28 to 9.31 of the report provide a damning indictment of the current situation. Its second volume, which contains all the evidence received, adds powerfully to that indictment. The key recommendations on allergy centres—those described by the noble Baroness when opening the debate—in Paragraphs 9.40 to 9.46 of the report, on NICE clinical guidelines in Paragraph 9.47 and on education in Paragraph 9.48, demand a full and adequate response.
	However, the Government response to all these recommendations is deeply depressing. They refer to a review carried out by the Department of Health and then make use of that review to justify one of the most inadequate responses ever given to a report by a Select Committee of this House, made much worse because, effectively, it is also a response to a committee of the other place that came to similar conclusions. They argue that,
	"lack of baseline data ... published examples of whole systems modelling of services ... analysis of the effects of active demand management of patient flows in allergy care ... absence of agreed service models and protocols",
	and,
	"the presence of differing perspectives of professional groups",
	make it impossible to make meaningful comments on the existing and desirable capacity of services for allergy. Surely that is not an adequate response to the recommendations but an admission that the Department of Health has failed to do its job.
	If all those business jargon phrases that I have quoted identify work that should have been done, the question is why it has not been done and why the information is not available when provision of services is identifiably inadequate and huge sums of taxpayers' money is being put into the health service. One thing is absolutely certain: with that kind of guidance, few with regional responsibilities will make a positive move to improve the service and provide the allergy centres that the report recommends.
	We are told that none of the allergy-related,
	"topics has been judged to be of sufficient priority against other proposals to warrant inclusion in NICE's ... programme".
	That represents a combined failure by both NICE and the department to address priorities that have been identified by two parliamentary committees on the back of a mass of evidence. As to education, I suppose that we are expected to find comfort from the statement that the Department of Health,
	"does share a commitment with statutory and professional bodies that all health professionals are trained, so that they have the skills and knowledge to deliver a high quality health service to all groups of the population with whom they deal",
	even though the department first washes its hands of responsibility for setting curricula for health professional training. However, it really is not good enough to be fobbed off with the feeble comment that the department,
	"would encourage the Royal Colleges to work together with the bodies responsible for medical training at all levels, in order to ensure that the knowledge and expertise of those working with people with allergies are enhanced",
	and with the recommendation that,
	"early attention should be focused on the knowledge and skills of all clinical staff".
	If I appear angry and impatient, it is because I am. That anger and impatience are shared by a large number of professors and consultants in the field, many of whom signed a devastating letter to the Times, which appeared on 31 January. Today we are considering a report that identifies grave shortcomings in the knowledge and training of a large number of health professionals, who as a result are unable to provide the quality of service that is, I am sure, their ambition and the understandable and justified expectation of their patients. It is the job of Ministers to ensure that shortcomings, when identified, are remedied. It is they and not others who should be held responsible if remedies are not found. With a Minister rightly described in the debate as highly qualified, perhaps at long last there is hope.

Lord Rea: My Lords, as always it was a great privilege to serve on your Lordships' Science and Technology Committee. We were extremely lucky to have such a cheerful and energetic chair. She has already paid tribute to our specialist adviser, but I should like to pay special tribute to our clerk, Sarah Jones, who came through her initiation as a committee clerk with flying colours. I also thank our hosts on external visits, who went out of their way to make us feel welcome and arranged fascinating and informative programmes.
	I am not an allergist or an immunologist but, as a general practitioner without special training in allergies, I saw many patients with allergy problems. The great majority of these could be helped by simple measures to mitigate the symptons. Inhaled, topical and, occasionally, systemic steroids were extremely useful, as were antihistamines and cromoglycate. I usually referred more severe or intractable problems, mostly asthma or severe skin allergy, to the appropriate chest or skin specialist. It was difficult to get an early NHS appointment to see our one allergist in the catchment area, who always had a long waiting list. I was fortunate never to have to deal personally with a severe anaphylactic reaction, though one of my patients died as a result of a wasp sting while on holiday in Greece.
	I have suffered a moderately severe reaction myself as a result of a wasp sting, dealt with competently and effectively by the A&E department at the Royal Sussex Hospital in Brighton. Subsequently, I received a long drawn-out but effective course of desensitisation at Professor Stephen Durham's unit at the Royal Brompton. I know that it was effective because, a year or so later, I was stung eight times at once after treading on a wasp nest in the dark—an experience not to be recommended. Thanks to my desensitisation, it was not a fatal experience—as it might have been, because I had left my EpiPen at home.
	In my practice, it would have been extremely useful if one of our practice nurses had received training in the use of patch testing and other allergy diagnostic procedures. As it was, we had only empirical knowledge of the allergens that triggered allergic responses in patients. In many cases, no single factor seemed to be responsible and control of the symptoms—whether a skin rash, wheezing attack or rhinitis—was the doctor's sole aim, rather than finding out exactly what was causing it.
	The main recommendation of the report—to establish a network of specialist allergy centres similar to the one that the committee visited in Cambridge—would make that much more possible. Not only could patients with troublesome allergies be referred there, but GPs and practice nurses could be trained in allergy procedures, as the noble Lord, Lord Crickhowell, suggested. Already, at the Cambridge centre, GPs have improved their allergy skills through their correspondence through referrals. My noble friend will know of the new allergy centre proposed for Manchester, which the noble Baroness, Lady Finlay, mentioned, which consultants want to set up and requires only modest funding. I understand that my noble friend's colleague, Ann Keen, has agreed that the Manchester Centre should be supported, but so far, no funding has been agreed. Can my noble friend give us good news here?
	The rise in allergic disease in the past few decades—which all our witnesses mentioned and which is well understood to be real and not simply due to changes in clinical awareness or diagnostic criteria—has occurred in all modern industrialised countries, not merely in Britain, although we have perhaps had the highest rise. It has not occurred among the populations of developing countries living a traditional lifestyle but, interestingly, it has increased to some extent among the better-off members of those societies, whose standard of living is similar to ours. As we have heard, that phenomenon has been labelled the hygiene hypothesis: those at greater likelihood of exposure to more infections, infestation, environmental pollution or certain foods very early in life—possibly even in utero—are less likely to develop allergies as older children or adults. The clean, the hygienic, thus has a downside. That is perhaps another way of saying, "A bit of dirt never harmed anyone"—and may even do some good.
	An example of research carried out in Berlin and Munich on whether the hygiene hypothesis applied was described to us; it has already been alluded to. Before the unification of Germany, the incidence of allergic disease was lower in poor children in the east, where there were higher levels of atmospheric pollution than in the west. After unification, which led to less pollution and higher living standards in the east, levels of allergy gradually rose, so that there is now no difference between east and west. In rural Germany, children brought up on farms, exposed to animals and drinking unpasteurised milk, had lower levels of asthma and other respiratory problems than children in the same area not living on farms. Research that has been described to us, as noble Lords will have heard, by Professor Gideon Lack at the Evelina Children's Hospital demonstrated that the prevalence of peanut allergy in Jewish children living in Israel was much lower than in genetically similar children living in the UK. As my noble friend has described, the Israeli children had been weaned on to a food based on peanuts. I will not describe the study known as LEAP—Learning Early About Peanut Allergy—which Professor Lack is conducting because it has already been well described.
	As its name suggests, the hygiene hypothesis is a hypothesis rather than a full explanation, as there are many exceptions to the rule. It is not much help being allergy free if, as a result of living in an unhygienic environment, a young child were to get seriously ill and fail to survive to enjoy its allergy-free status. However, the hygiene hypothesis may be helpful in understanding the origins of allergy. The mechanism of the immune response to certain bacilli—possibly in the gut flora—in early life appears to enable an individual to deal more efficiently with potentially allergenic challenges later.
	Research to identify and understand the processes involved in the acquisition of tolerance early in life has far-reaching potential, and hopefully it will be possible to identify and isolate at a molecular level the factors in the "unhygienic" environment initiating this process. Thus "clean dirt" could be given to vulnerable individuals, enabling tolerance to develop without the long process involved in a desensitisation course. Here, however, I am speculating beyond the evidence that we received. The purpose of my remarks is to underline the importance of stable or increasing government funding to enable the high-quality basic and epidemiological research in this country to continue. The noble Earl, Lord Selborne, and the noble Lord, Lord May, described this very well.
	Food allergy is an increasing problem. Although many who think they may be allergic to certain products—according to some estimates about a quarter of the population at some time in their life—may in fact be suffering from food intolerance or ascribe a variety of symptoms to certain foods, encouraged by some complementary practitioners and the media, rather than having a true allergy mediated by IgE or T helper cells. Five to seven per cent of infants are thought to have some manifestation of true food allergy, but the figure is not precise due to diagnostic difficulties. This prevalence reduces to about 1 to 2 per cent of adults, according to the Institute of Food Science and Technology. As has been said, peanut allergy has increased in prevalence so that about 25,000 people may now be affected. New food allergies are being described, such as to kiwi fruit and certain other fruits, tree nuts as well as ground-nuts, chickpeas, sesame, mustard and soya. Dr Clare Mills of the Institute of Food Science and Technology ranges potentially allergenic food products in a hierarchy of severity, with peanuts and hazelnuts at the top of the list and carrots, tomatoes and melon at the bottom.
	To conclude, the European Union is reviewing its food-labelling legislation. This should provide an opportunity to rationalise what is at present a confusing set of regulations that cover only 12 known allergens added to food. The list is constantly changing. The review should provide the Food Standards Agency with an opportunity to influence the rationalisation of EU food labelling legislation. Our report recommends that food labels should specify the amount of each allergen listed if it is contained in the product, and we support the FSA in discouraging vague, defensive warnings which can severely restrict the choice of those with possible allergic tendencies, especially if they are of a cautious disposition.

Lord Soulsby of Swaffham Prior: My Lords, much of the fundamental research on allergy and its management has been done in the United Kingdom, and yet with allergy reaching epidemic proportions, this report of the sub-committee so ably chaired by the noble Baroness, Lady Finlay of Llandaff, and guided by our expert adviser, Professor Barry Kay, identifies major deficiencies in allergy services in the country, including a shortage of specialists, lack of training and deficiencies in management when compared, for example, with the continent of Europe.
	I wish to focus on immunotherapy in allergy. Immunotherapy, or desensitisation, can lead to a potential cure for an allergy rather than merely alleviating the symptoms with drugs. Immunotherapy has been found to be highly effective in numerous rigorously controlled clinical trials. Importantly, desensitisation treatment has scored well at the highest level of scrutiny such as meta-analysis using the Cochrane database. The treatment, which consists of administering graded increasing doses of whatever the person is allergic to, such as pollen, dust mites, bee and wasp venom, is a specialist procedure that is best undertaken by a specialist. Immunotherapy, given either by subcutaneous injection or drops under the tongue, is the standard treatment for common allergies in virtually every country in the developed world with the exception of the United Kingdom. We found that it is hardly used at all, and there appear to be two reasons for this.
	The first is simply a lack of UK allergy specialists. The second seems to be reluctance bordering on obstruction by the Commission on Human Medicines to approve licence applications for allergen immunotherapy given by injection, bearing in mind that, world-wide, immunotherapy is still mainly given by injection, and at present most allergy products are only available in injectable form.
	The sub-committee was informed in written evidence from the Medicines and Healthcare Products Regulatory Agency that the UK uses the mutual recognition procedure for immunotherapy products in the same manner as other treatments. Yet we were told on our visit to a Danish vaccine company, ALK-Abello, that this appears to be far from the case. For example, one of that company's products, Alutard SQ, used to treat grass, tree, cat, dog and house dust mite allergies, has been licensed for use in many European countries for decades. The company told us that in December 2005, Sweden as the reference member state approved Alutard SQ for grass allergy and submitted the file to six European member countries for approval, including the United Kingdom and Ireland. All the countries approved Alutard for use in hay fever with the exception of the United Kingdom. Furthermore, when a revised application was submitted to the MHRA, the company was informed that the position had not changed and, as a consequence, ALK-Abello had withdrawn its file. In other words, this company and no doubt other allergy product companies think it simply not worth their while trying to get an allergen immunotherapy product licensed in this country.
	So one might ask why the bar for approval of these products in the UK as opposed to all other European countries is set so high. Is it still the mindset of the 1980s when deaths occurred because this specialist treatment was being administered by untrained personnel to poorly selected patients using crude vaccines in GP surgeries? That is possible, but we have moved on. We must now remove the obstructions to effective allergy practice by making immunotherapy to a range of allergens widely available for UK allergy sufferers. The obvious place for immunotherapy clinics is at our proposed allergy centres. Perhaps MRHA would be more flexible in granting licences for a wider range of allergy products when they are administered by experts in these centres of excellence, rather than continuing with the present unsatisfactory situation in which most products are imported on a named-patient basis.
	We also urge NICE, the National Institute for Health and Clinical Excellence, to evaluate those products currently on the UK market which have been subjected to thorough, controlled clinical trials. For example, bee and wasp sting anaphylaxis accounts for several deaths a year and remains often undiagnosed. For these patients, venom immunotherapy by injection can give life-saving protection, but few centres have the facilities for offering this treatment. Endorsement by NICE of bee and wasp venom vaccines would go some way to raising the profile of allergen injection immunotherapy.
	Finally, there is the question of oral immunotherapy, in which the allergen is given under the tongue as sublingual drops or tablets. This is safe and effective treatment which can be self-administered by the hay fever sufferer at home. Mr Andrew Dillon, the chief executive of NICE, said in evidence that he had no plans to evaluate the oral hay fever vaccine Grazax. Why is this? The popularity of sublingual immunotherapy is growing year on year, especially among European and American allergists. Why do we have such a negative response to a treatment which has been subject to a Cochrane review and evaluated by numerous robust clinical trials?
	The Government's response to our submission on immunotherapy occupied five lines and concluded:
	"If immunotherapy is given sufficient priority by the Department of Health, Ministers will consider it for referral to NICE".
	This in a situation where, as the noble Baroness, Lady Finlay, said, we are the laughing stock of the European Union with respect to allergy treatment. The irony is that although allergy immunotherapy was pioneered in the United Kingdom more than 100 years ago and many of the landmark clinical trials have been performed in this country, it seems to be the rest of the world, not us, which have benefited from that research.

Lord Lipsey: My Lords, as this debate has shown, yet again, there is no subject on which there are not a number of people in your Lordships' House who are highly expert—many, in this case, as a result of serving on the committee so excellently chaired by the noble Baroness, Lady Finlay. I bring a different expertise, which has been shared by at least one other noble Lord, that of a sufferer.
	Because one likes to excel in life, I was rather chuffed when I went into my doctor's surgery three years ago and he said, "My God, David, that is by far the worst case of hay fever that I have ever seen in all my years of practice", and he packed me off to the Hereford Eye Hospital. I am half-way through a course of immunotherapy which is, so far, working for grass but not for tree. In order to be in your Lordships' House this afternoon, I am on 20 milligrams a day prednisolone steroids—nasty stuff steroids, incidentally; 180 milligrams of fexofenadine, which is a strong antihistamine; hourly doses of sodium cromoglicate eye drops; four doses a day of antihistamine eye drops; nasal steroid spray; and piriton to send me off to sleep at night. So it is obviously not trivial going through all these treatments, especially if you still look like a living monster. I mention that not only to get the sympathy of the House, although that is always nice, but more seriously to make three points.
	First, the only reason why I am here this afternoon is that I am receiving treatment at Guy's Hospital from Professor Chris Corrigan and his wonderful specialist allergy team. They gave me new heavy-duty antihistamines, which would not be known to many GPs. My GP is excellent and he had only just heard about them. It is only because I am able to receive that specialist treatment that I am not lying down in a dark room, moaning, at this moment.
	My second point is more important, goes to the heart of the debate and is about the importance we tend to attach to allergy. There is a feeling that allergy, even if you get it quite badly, does not rate highly in the league table of human suffering. It does not really matter and the health service should be concentrating on things that save people's lives, rather than things that make their daily existence more comfortable. I make one or two points on that. A noble Lord, whom I will not mention because he is not in his place, quite often sits next to me in the allergy clinic because his life is threatened without immunotherapy. One bee sting could do for him. Therefore, he has to be there; that makes his treatment high-priority. These are, of course, terribly difficult questions of priority.
	In addition, this is something that you can start having at an early age and which, without treatment, can knock you out for four months of every year, right through your lifetime, until you die. Sometimes, quite seriously, you wish when you have it that you were dead. There is a case for priority to be given to that, even over things that are life-threatening but may only be so to people who will have relatively short spans of additional life if they are treated. There is a case to be weighed there.
	I pick up a point made by the noble Lord, Lord Taverne. A balance has to be struck in weighing risks. I had a first symptom-free period of eight or ten years when I was injected with immunotherapy by my GP. That was made illegal after one or two people had dropped down dead in doctors' surgeries. Doctors' surgeries are now much better equipped to cope if somebody keels over as a result of the treatment they are getting, and will be even more so when the Minister has finished his report. I am not quite clear, delightful though it is to be in the allergy treatment room, that sitting there for an hour after each jab is absolutely essential to my survival, and could not equally well be done in a doctor's surgery, with greater convenience in many cases. To take another example of risk, there was a very good drug, from which many sufferers benefited, called Triludan Forte, which was banned after a few bad reactions in a million had occurred in the United States. There was a suspicion that it was associated with heart disease. It was worth the risk as far as I was concerned. We must not let risk stand in the way of important advances.
	Thirdly, in my experience, everything I have seen underlines the importance of the recommendations made by the noble Baroness, Lady Finlay, and her committee in their excellent report, particularly about the availability of centres of excellence. I am at a centre of excellence. The lady sitting next to me travels for two and a half hours every week to go to that centre because it is the nearest to her. She sits there for two hours and then travels back for two and a half hours. She will have to do that for three years and more than 30 sessions. This is not a negligible price to impose. It is worth it for her, but it shows that, where possible, we should have centres nearer to people's homes. She does not live anywhere very obscure. What would it be like if you lived, say, in the north of Scotland? I hate to imagine. The necessity of having these core places with the core skills available, led by a consultant but with the right team of people with the right experience, cannot be overestimated.
	Some disobliging things have been said—I understand that, having read it—about the Government's response to the noble Baroness's report. I did not feel that the response was wicked or dismissive so much as that the department felt that with so many things on its plate, understandably, it did not really wish to grasp this one. It was just a step too far—too much to take on. The same has clearly been true of NICE, as we have heard. No one seems to want to give this the small but decisive push that it requires to be treated properly. I say to the Minister and to the House only that there are hundreds of thousands, maybe millions, of people like me who wish that they would.

Lord Colwyn: My Lords, the noble Lord, Lord Lipsey, should be congratulated. Without being too light-hearted, I must say that if he is on that cocktail of drugs, I am surprised that he managed to stay awake during his own speech today let alone others.
	I also thank the noble Baroness, Lady Finlay, for her chairmanship, Professor Barry Kay for his specialist advice and Sarah Jones and Cathleen Schulte for their backup on this inquiry. The key theme that has emerged from the report is that allergy in the UK has reached epidemic proportions, with more complex and sometimes life-threatening new allergies emerging almost daily. Advice to sufferers varies: should the hygiene theory, as described by the noble Lord, Lord Rea, be supported or rejected—cats and dogs and dirt—or should we take every opportunity to isolate our children from possible allergens? The noble Baroness, Lady Finlay, and the noble Lords, Lord May and Lord Rea, have already discussed peanut allergy and advice given for very young children as a good example of that.
	About 20 million children and adults in the UK suffer from a form of allergy, and from April 2006 to March 2007 there were 67,077 emergency hospital admissions for people experiencing just an asthma attack, 40 per cent of whom were children under 15. A simple allergy can be an early step on the allergic march towards more serious allergies, and the critical impact of allergy on health and quality of life and its potential to cause fatalities, usually in older children and adolescents, should not be ignored. Allergic disorders are usually chronic and low-intensity but can have serious effects on quality of life for both patients and their families, and in extreme cases can even lead to death. The prospects of unexpected allergic catastrophe or anaphylactic death are real issues for many families and should not be underestimated.
	Many common modalities of treatment are outdated and put sufferers at significant risk of side effects, when modern, safe treatments are more effective but not widely available. Allergy treatments are a significant cost to the NHS, and symptoms can have a detrimental impact on lifestyle, the education of children at school or the performance of adults at work. Many lifestyle factors are specifically associated with allergy and must be considered in the context of known or suggested risks for allergic diseases.
	Good health and the ability to fight off disease are a function of the immune system, and there are daily references in the media about how that can be improved. It has been suggested that pregnant women who lead a sedentary lifestyle may cause an increased risk of asthma in later life. Recent studies have shown that levels of vitamin D, found in food such as oily fish and boosted by natural sunlight, can influence the development of a child's lungs and immune system while in the womb. There is also a possible link between asthma and obesity; the numbers of people with both problems have soared in recent decades. It has been suggested that handling rubbish that has been left out for two or more weeks before being collected can increase the risk, as the level of bacteria and fungal spores above bins that have not been emptied is more than 10 times higher than in locations where there is a weekly collection. Keeping a cat can allow the onset of allergic symptoms: a study from Imperial College found that increased exposure to cat allergen was associated with greater sensitivity of the respiratory system.
	Blame has been put on the possibility of a defective gene that plays a key role in the appearance of allergic symptoms that occur when the immune system wrongly identifies allergens such as dust mites, pollen, peanuts or cat hair as being dangerous. Scientists have also identified a cold-fighting protein which asthmatics lack. The common cold triggers about 85 per cent of asthma attacks in children, and 60 per cent of those in adults. A study by US scientists has shown that sufferers of allergic rhinitis appear to be at much greater risk of the degenerative brain condition, Parkinson's. About 5 million Britons are affected by perennial allergic rhinitis, usually triggered by indoor allergens such as dust mites, pet skin flakes and spores, causing inflammation and irritation to the delicate linings of the nose and eyes. A further 3 million suffer from a mix of perennial and seasonal rhinitis, or hay-fever.
	We need accurate data, so I commend our recommendation that the Department of Health should ensure that the Systemised Nomenclature of Medicine system, supported by appropriate training, ensures efficacy as a simple, consistent classification system to record allergic disease, monitor its prevalence and inform the commissioning of allergic services.
	Whatever measures are taken to minimise the risks of allergen contamination, ultimately some responsibility must lie with the allergic consumer. Social difficulties can make sufferers reluctant to take necessary precautions, and many young people take risks with foods carrying a "may contain" label, believing that food companies are covering their backs with a generalised warning. Children at school risk contact with allergens such as nut proteins, which are easily transferred between surfaces, and if their understanding of their allergy is poor, they can suffer high levels of anxiety. That sometimes leads to a panic-attack reaction. Although minimal, the possibility of anaphylaxis at schools causes great worry to children and their parents, while placing a burden on the school by requiring members of support staff and teachers to be able to deal with emergencies.
	In the year to 30 September 2006, about 165,000 prescriptions were dispensed in England for Epipens, at a cost of about £8.2 million. The quick dose of adrenaline which these automatic injectors provide can be life-saving for people suffering an anaphylactic shock to food, insect stings or allergens known to the patient. We had evidence that these auto-injectors were not being used effectively. I agree with my noble friend Lady Perry that it might be a good idea for schools to have their own supply of adrenaline injectors, for use by a trained member of staff or a school nurse, rather than relying on children to carry their own medicine. The prescription of such auto-injectors requires specialist allergy knowledge that is currently lacking among many general practitioners and needs to be coupled with patient training. The establishment of allergy centres and the further education of practitioners in allergy should improve the quality of training provided to patients about administering their treatments.
	Many patients turn to complementary therapy to diagnose and treat their allergy, usually because they are unable to obtain proper diagnosis from their GP or stand no chance of being referred to a specialist. Many patients are worried about the side effects of conventional drugs. As president of the All-Party Group for Integrated and Complementary Healthcare, I was disappointed by the lack of response from complementary practitioners to this enquiry. Homeopathy, herbalism, acupuncture, cranial osteopathy, applied kinesiology and methods of self-testing, including Vega hair and blood testing, were dismissed as having no scientific evidence or mechanistic base to suggest that those treatments and tests could be remotely effective. Although I know that that is not true and I have sent patients for these treatments with success for many years, there was little evidence to present to the Committee to back up my belief.
	We heard the argument that complementary practices may delay accurate, valid and pressing diagnosis, leading to medical harm. I regret that the lack of evidence did not enable us to assess the beneficial effects of complementary therapies, which are harmless when compared to those of conventional drugs on the thousands of people who are harmed or die needlessly as a result of idiopathic reaction.
	I am delighted that the Government accept that research into the effectiveness of complementary treatment should address the outcomes that we have identified, and I hope that the Minister will give serious consideration to the points made today.

Viscount Simon: My Lords, as I am the last Back-Bencher to speak, what is there left for me to say? Not a lot, unless I repeat matters raised by other noble Lords, and I shall do that occasionally.
	The Select Committee of which I was a co-opted member, chaired very efficiently by the noble Baroness, Lady Finlay, investigated the subject before it with great enthusiasm. Numerous knowledgeable witnesses were questioned in great detail. Most of them were helpful but one or two who tried to impress us were not. What impresses me is the almost universal lack of understanding of what allergy is, and this includes people who are medically qualified. This came over loud and clear when witnesses were questioned.
	In response to a question last week in another place about the small number of allergy specialists, the Minister listed the large numbers of consultants in dermatology and respiratory medicine and of GPs. The stark reality is that very few of these treat allergy. The services they offer are complementary to allergy but cannot be a substitute for allergy treatment. These doctors do not make an allergy diagnosis or identify an allergic trigger; they diagnose only the single, specialised area covered by them.
	Of course, the key problem in providing allergy care is a lack of doctors trained in allergy, and the fact that there are only a few allergy specialists. Currently, only a few doctors are being trained as allergists—a specialty in which it takes some years to become fully trained—and few places are available for those interested in this specialty. More posts for doctors to train in allergy need to be created and funded and there need to be more posts for consultant allergists.
	I believe that existing allergy centres are somewhat fragile because most operate on academic funding and there is insufficient NHS funding. This means that when the head of department retires or leaves, the service can disappear. A small amount of NHS funding is needed in these centres to secure them long term. The cost need not be great—two extra consultants, a trainee in allergy, two half-time allergy specialist nurses and a part-time dietician. This would produce trained staff who could then be seeded out to set up centres in areas of the country where there are poor allergy services.
	In relation to the large patient need these costs are extremely small. In addition, improved services would result in cost savings for the NHS. Identifying allergic triggers will stop further allergy such as episodes of anaphylaxis, severe asthma and many other conditions. This, in turn, would result in reduced use of health service resources; for example, fewer A&E attendances, hospital admissions, GP consultations and a reduced need for drugs. I very much hope that the Minister will acknowledge that.
	Last week I was invited to a reception hosted by the Spinal Injuries Association. I spoke with a senior consultant about the specific areas she covered and about many other matters. When I raised the subject of allergy her immediate response was that there are not enough trained allergists around—I am almost inclined to use that old-fashioned cliché "north of Watford"—with most of the country being without any at all. I found her knowledge refreshing and, at the same time, sad. She knew that there is little happening to alleviate the problems caused by the epidemic of people with allergies.
	But at least there is a start in addressing the problem. A new regional allergy centre is being created in Manchester. If this is adequately funded and if those working there are suitably trained, the benefit to the public purse and to the patients will become patently obvious very quickly.
	The report of our Select Committee has, I hope, highlighted the requirements of those suffering from allergic conditions. I am one of them. Fortunately, I am being tended by a consultant allergist nearby but many are not, and that is what concerns us all.

Baroness Barker: My Lords, when the hunting legislation was going through your Lordships' House I was asked by another Peer whether I had ever hunted. When I said no, that Peer was rather disparaging. I redeemed myself only by saying that I had not done so because I am severely allergic to horses. The one and only time in my life I have been on a horse I looked about as good as the noble Lord, Lord Lipsey, does today. As I have that very common battery of allergies, I was delighted to spend last weekend reading the noble Baroness's excellent and thorough report.
	I want to focus on the issues that noble Lords have raised but put them into a context. The context is that there will in future be nothing like the level of funding in the NHS that there has been in recent times. Therefore, for any service, particularly a specialist one like this, it is a question of how we redesign services in order to make what we have more effective. From data gathering and management at the beginning of this report right through to the end, the noble Baroness and her committee have offered the House and the noble Lord, Lord Darzi, an excellent blueprint for how services can be redesigned.
	I am not a scientist or a historian, but other noble Lords have referred in their speeches to population conditions 100 years ago. Forgive me if I am wrong, but I think we need to be a bit careful. The survival rates from anaphylaxis 100 years ago would have been pretty near to zero. Although great advances have been made, the noble Baroness is right that the overall picture on prevalence is, when set against advances in public health, truly disappointing. I would go further and say that, if anything, some of the figures in this report and in previous reports by the Royal College of Physicians and the Health Select Committee are probably underestimates. Why? Because most people, like me, do not have severe and acute reactions and manage the condition themselves. Therefore, I suspect that the NHS really gets to see only those who are towards the more acute end of the spectrum. Moreover, those who have allergies are increasingly using the internet to find ways round and manage things for themselves.
	The report is a disappointment in that very little appears to have changed in the 40 years since I sat in my GP's surgery with pinpricks up my arms, watching all the reactions take place, and was sent off home with a list of things to avoid and a tin of Betnovate for when the eczema got really bad. The only thing that has changed is incidence. I thought one of the most interesting findings in the report was the observation by Professor Custovic of Manchester University that the genetic background of the population has not changed dramatically and yet the incidence of allergic disease has. That is worth noting.
	I know something else anecdotally; I have tried desperately to find data on it but have been unable to. I understand that in the Italian population there is a high and growing incidence of coeliac disease. As a very good friend of a member of my family has coeliac disease, I know that you can go to Italian restaurants even in this country and find gluten-free pasta. That is increasingly the norm in Italy. It is interesting because in the past 20 years people in this country have adopted a diet with a lot of Italian food in it. I just wonder whether it is another form of allergic disease for which we should be taking preventive action.
	I agree with the noble Lord, Lord Rea, that the issue of food labelling is tremendously important. The only thing that one can do with a food allergy—and they tend to be very violent—is avoid the substances that you know you are allergic to. It is useful that EU directives are increasingly updated, but they are unclear. The food industry needs to know that it is not in its interest to have unclear labelling. I hope that, with the FSA, work can be done to improve that.
	As somebody who frequently has reactions to skin products and soap, it was a delight to have my own anecdotal feelings set down as being right—namely, that the terms "hypoallergenic" and "dermatologically tested" are meaningless. There is absolutely no way of knowing whether a particular product will set off an allergic reaction. I shall make one point which for obvious reasons is not in the report. As someone who experiences such reactions, I have always wondered why it is impossible, when one has a mild allergic reaction to a product, to draw that to the attention of the manufacturer. I suspect that I am like thousands of other people; I do not want any kind of redress, I do not want money and I do not want to pursue them through the courts. I simply want to tell them that something has happened to me in the hope that they will record that systematically and begin to build up a picture that, somewhere down the line, will either make their product better or help other people. I wish that somehow the Government could encourage especially the cosmetic industry to do that.
	I speak at some risk about alternative therapies, because I know that my noble friend Lord Taverne has very strong views on them. A large number of people are turning to alternative therapies, principally because they fear prolonged use of steroids. I cannot blame anyone for seeking relief from some of the symptoms of allergy. If they choose to do that, they should do it in a way that is integrated with conventional medicine. I hope that the department responds to that.
	In the National Health Service, we have an unprecedented facility to study allergic disease and not only to conduct trials, but to do population-controlled trials. This morning, someone in my house asked me what I was going to do today, and when I told them about this debate, they said that they developed an allergy when they went to a particular university. Apparently it happens to loads of people who go to that university, because it is surrounded by fields of rapeseed which is a very potent allergen. If we can do nothing else with the regional allergy system, we could look at the incidence of that kind of condition.
	Regional allergy centres are important, and they will have to be formed not by the creation of specific new posts but by drawing together and clustering experts who already exist across the field. The key importance of regional allergy centres is twofold. First, they deal with those who have acute and life-threatening conditions, as the noble Lord, Lord Lipsey, said. Secondly and importantly, they can increase the skills in primary care, because that is where the bulk of people who have such conditions go for diagnosis, reassurance and treatment. I wish the report well, and I hope that the Minister accepts its recommendations.

Lord McColl of Dulwich: My Lords, this is a first-class report, as has been mentioned several times; it is highly professional, lucid and well illustrated, and the House is rightly grateful to all those who have taken part, especially to the chairman, the noble Baroness, Lady Finlay of Llandaff.
	The report draws attention to the centre for the study and treatment of allergy, which emanated from Guy's Hospital, which is where I continue to work. The centre is directed by Professor Tak Lee, and it is known as the MRC-Asthma UK Centre. It is the only centre of its kind in the country. It is a collaboration between the MRC, Asthma UK, King's College, Imperial College, the hospitals of Guy's and St Thomas's, King's, Royal Brompton and St Mary's. As the report says,
	"all the organisations had been able to combine their research strengths into one cohesive strategy for the first time".
	The centre also works with general practices in east London. It focuses on teaching, research and patient care. Many more similar centres are required urgently throughout the country, as has been said, and that has been the verdict of several recent reports. All have emphasised that there are fewer allergy centres in the UK than in Europe and the USA yet nothing seems to have been done to increase capacity. Ministers have made the excuse that it is the fault of the PCTs whose job it is to make these decisions.
	But Ministers know that PCT's have never been accused of understanding complex subjects like allergy. As has been mentioned, the Times newspaper headline of 26 September stated,
	"Britain 'is the laughing stock of Europe' for its neglect of allergy cures".
	Ministers need to give a lead. We desperately need a big drive from the top.
	Irrespective of any single centre that may be created in the future, right now there are some departments around the country that have critical mass and already fulfil many of the criteria that the report recommends for a centre; for instance, Cambridge, Southampton, the Royal Brompton with St Mary's, and Leicester. For a relatively small amount of extra investment one could create a number of allergy centres as envisaged by the report: for example, the extras that would be required would be a half-time dietician, one full-time specialist nurse and one paediatric and one adult allergist.
	We also need to put money into trainee slots; there are only 12 of these, known as SBRs, in the whole country—one for every 5 million of us. That is totally inadequate to provide, first, a network of NHS services uniformly across the UK and, secondly, the leadership for training a future generation of allergists. While some academic allergy trainee posts have been created—this is very welcome—the numbers are still insufficient to make a significant impact on clinical allergy service provision especially in paediatrics, as the noble Viscount, Lord Simon, mentioned. The numbers simply could not meet the recommendations of their Lordships' report. Why not move some of the excess unfilled training numbers in other specialties into allergy? Will the Minister tell the House why that cannot be done in the next month?
	Of course, any increase in trainee numbers needs to be matched by an increase in the number of consultant posts to build capacity. The charity Asthma UK has drawn attention to the large number of hospital admissions in England for patients with an asthmatic attack. My noble friend Lord Colwyn mentioned that from April 2006 to March 2007 there were over 67,000 emergency admissions, 40 per cent of which were for children under 16. It estimates that 75 per cent of those admissions could be avoided with good asthma care.
	Professor Tak Lee emphasises that there are many professionals treating patients with asthma but they concentrate on treating the symptoms but fail to look for the cause of the asthma, failing to hunt for an allergic basis for the problem. That is why it is so important to have allergy experts involved in the care of these patients. Accurate diagnosis is so important, as the noble Lord, Lord Bhattacharyya, stressed. I was especially interested in the section on allergy in the school environment, where the problem of hay fever during examinations is discussed and mentioned by the noble Baroness, Lady Finlay, and the noble Baroness, Lady Perry. For many years I have advocated that one solution would be to hold the examinations in March or April. However, the congenital snag hunters have always dismissed this out of hand, as is done in paragraph 5.25 of the report, where a senior civil servant stated that,
	"the structure of the school year is based upon centuries of history ... It would not be practical to suggest an alteration of the examination timetable purely to benefit hay fever sufferers".
	Have we not heard that before? That civil servant seems to have forgotten that the examination system has been radically altered dozens of times in the past 60 years. Perhaps he is unaware that the baccalaureate exam is held in May, and the GCSE drama examination was held in April this year by some of the examination boards.
	It is not only hay fever sufferers who would benefit from that change, but the thousands of candidates who suffer intolerable heat in the height of summer in poorly designed examination halls, even in quite expensive public schools. A sauna can be an enjoyable experience but not in the middle of a crucial examination which will determine one's career for life. There would be other advantages—for instance, the summer term could be spent by pupils engaged in more practical work to prepare themselves for citizenship, charitable enterprises and so on. And the examiners could complete their tasks before the summer holidays. This would have a further advantage in that it would allow the universities to make final decisions on their entries before August and do away with the need to allocate provisional places—which creates chaos.
	Another aspect of the report deals with the most dangerous of all allergies; namely, anaphylactic shock. This may be caused by many different antigens, including peanuts, drugs, insects and so on. In order to deal with this hazard and forestall disaster, those who are known to be susceptible are provided with the devices that have already been mentioned—EpiPen and Anapen. There is confusion about who can help the child in school and whether anyone should do. The report rightly recommends that staff should be taught about how to deal with these emergencies and have clear guidance. Potential sufferers have to carry the adrenalin themselves, as well as it being available in school. As this is so important, can the Minister assure the House that what must be a relatively straightforward matter is sorted out quickly without resorting to umpteen meaningful, ongoing working parties and committees, which the Minister and I used to call group psychotherapy meetings when we worked together in surgery?
	This subject brought to the surface some strange comments in the report. One witness, at paragraph 5.35 suggested that these adrenalin auto-injectors were overprescribed. He said,
	"of countless prescriptions I have written over the last 12 years for such devices only one has ever been used".
	Perhaps that witness should have been asked how many of the fire extinguishers in his area had been used in the past 10 years. I always have in my pocket ampoules of adrenalin and hydrocortisone with a syringe and needle. These are probably the only drugs that are required immediately—and there is never time to get them. Recently, I was presented with two patients in anaphylactic shock due to the stings of French hornets. Had I not been carrying these essential drugs, one of the patients might well have died; although of course one can never be certain. Medicine and prophecy are two quite separate subjects.
	To many people it is a puzzle how anaphylactic shock actually kills the patient. The cardiovascular system is greatly impaired, blood pressure drops to the boots, and the excess fluid which rapidly collects in the tissues obstructs the larynx because the fluid cannot escape downwards, as the lining is firmly attached to the vocal cords.
	Finally, several noble Lords have described the key recommendations of the report in detail. My question is: when will the Government implement these recommendations, so that Britain will no longer be the laughing stock of Europe?

Lord Darzi of Denham: My Lords, I greatly enjoyed the debate. As my noble friend and others have declared their allergic reactions, I probably should declare my own. I am a hay fever sufferer and, for years, living from April to July has always been hell, although my asthma is certainly not as severe as that of my noble friend.
	First, I congratulate the noble Baroness on securing today's debate. I also congratulate her on the excellent work on allergy produced by the House of Lords Science and Technology Committee, which she chaired so ably. As my noble friend Lord Haskel pointed out, allergies affect the lives of millions of people in this country. Around one third of the population suffers from an allergy at some point in their lives and there are people in the House today, as we have heard, for whom this issue is of personal as well as national importance. The establishment of the All-Party Parliamentary Group on Allergy, of which the noble Baroness is a vice-chair, will help us make further progress. I wish the group success for their reception on 14 May.
	As the noble Baroness is aware, allergies are common and on the increase. In addition to the obvious health effects, allergic reactions can make unavoidable daily activities very difficult. They can compromise a sufferer's performance at work and, as we have heard, hinder children's educational progress. Clearly, allergic conditions represent a huge challenge, not just for our healthcare system, but for society as a whole. It is for these reasons that the Government welcomed the committee's report, which highlighted very clearly that allergy is an issue that needs to be addressed by a wide range of stakeholders.
	Noble Lords will be aware that in 2006, the Department of Health published a report of its review on allergy services. The review looked at the epidemiology of allergic conditions; the demand for, and provision of, treatments; and the effectiveness of interventions. This review was a crucial first step in building a programme of improvements that would be based on sound evidence, and would reflect the views of patients and healthcare providers. We are pleased that it was published in time to inform the inquiry led by the noble Baroness.
	Our review concluded that one key lever for changing allergy services in future will be local rather than national action. However, I sympathise with what I have heard today and the reasons so eloquently articulated throughout the House. I will take forward some of the suggestions made, but I still believe that we need to engrave in the NHS at a local level a self-improving system to deal with today's problem of allergies, as well as with other challenging long-term conditions such as dementia that we have debated in this House and that our NHS will face over the next decade.
	The report of the inquiry led by the noble Baroness made a number of recommendations to improve allergy services further. In their response, the Government committed themselves to taking action. Ann Keen, the Minister with lead responsibility for improving allergy services, recently met the noble Baroness to explore how we can work together to take forward the recommendations in the report. As we heard, she made a personal commitment to this report.
	Due to the pressure of time today, it will not be possible to run through every recommendation and all the actions that have been taken. I shall therefore focus on the committee's key recommendations and on some of the specific issues raised today, setting out what we are doing to address them.
	A lead strategic health authority should be established to take forward the development of a pilot allergy centre on a hub-and-spokes model. We agree that services need to be better organised if they are to meet patients' needs. Long-term conditions such as allergies are on the increase, and the Government feel that it is vital to change the disease management pattern in primary care if services are to be fair, safe and effective. Noble Lords are aware that, as part of my ministerial commitment, I spend most of my time providing leadership to the next stage review. I assure the House that that review will be looking at how we can build an infrastructure in primary care to take advantage of some of the innovations discussed here today.
	We are also in the process of exploring the feasibility of that approach with interested parties. As part of the consultation process, Professor Sir Bruce Keogh, our recently appointed NHS medical director, has written to all SHA chief executives asking them to declare whether they are interested in taking on this very important role. I have no doubt that Manchester will be a very strong contender. However, there are 10 strategic health authorities and I think it is only fair that they are all asked who should take on the leadership role. The process has started and will be completed soon.
	I turn to the issue of workforce planning and education and training, in which my noble friend Lord Bhattacharyya has personal experience. The noble Lords, Lord Taverne and Lord Crickhowell, raised the issue of our educational needs and competences in the service. The noble Lord, Lord McColl, highlighted the fact that last year we were able to create an additional five centrally funded training posts for allergy and a further five for immunology. In total, that is 10 posts. If the current figure is 12, that is near enough a 90 per cent increase in our training numbers. I have no doubt that we need to do significantly more, and we will continue to remind the workforce review team of the need to consider increasing training numbers in relation to allergy as part of its annual review programme.
	We have also encouraged the royal colleges to work with other bodies responsible for medical training to enhance the knowledge and expertise of those working with people with allergies. No doubt we all agree that the first contact that a patient makes is in the primary and community services, and if the competences for managing some of the demand from our patients out in the community are lacking, we have to do something about that. That issue is very close to my heart. I feel strongly that it should be part of our reform of primary and community services so as to meet some of the future demands on the service.
	As part of the annual review process, we have also endorsed the need for more training numbers for allergy. I have asked deaneries and trusts to examine whether they need to commission more local training posts for allergy.
	We also commissioned Skills for Health to work with stakeholders to develop national occupational standards for allergy for the UK in order to improve the quality and consistency of patient care. We anticipate that the standards will be published and implemented this summer.
	As well as training, health professionals need the tools to enable them accurately to diagnose and treat patients. We commissioned the Royal College of Paediatrics and Child Health to scope and develop care pathways for children with allergy symptoms. These will help to ensure that children displaying possible allergic reactions are given timely and appropriate care.
	I now turn to another area close to my heart, that of research. I have no doubt that I should declare my interest, still working in a university and carrying out research. The noble Earl, Lord Selbourne, eloquently highlighted the importance of research and reminded us of the committee's recommendation that further research should be undertaken to increase understanding of allergic causes. Work is being taken forward across government to increase our knowledge of these conditions. For example, the Medical Research Council and the Food Standards Agency are collaborating to fund a major new clinical intervention study on the effects of early weaning on food allergy. In addition, the National Institute for Health Research has provided some £4.7 million over five years for research on asthma and allergy.
	The noble Earl also raised the issue that more research needs to be carried out on early exposure and long-term cohort studies. Again, the NIHR has funded a project on primary prevention of asthma by allergen avoidance in infancy. The subjects were recruited antenatally and are now 17 and 18 years old. The occurrence of asthma and allergic diseases will be assessed and reported in due course.
	The other issue raised by the noble Earl, which again is extremely important and very much part of the next stage review, is how we can get a closer interaction between clinical need and the research excellence that we have achieved and in which we lead in this important field, not just nationally, but internationally. One of the review's enabling themes is to see whether we can find the right incentive for closer collaboration. Most of us know that we have created the first academic health science centre in this country. I have no doubt that your Lordships will agree that in a further such collaboration, bringing the two together, the power will be much greater than the sum of its parts. We need to exploit that for the future.
	Over the past few years, the National Institute for Health and Clinical Excellence has also produced a number of appraisals of allergic conditions and clinical guidelines for atopic eczema. Immunotherapy was another issue that was strongly debated today by the noble Lord, Lord Soulsby. We are and will be working with NICE to develop more focused allergy topic proposals, which will feed back into the NICE topic selection process. These include proposals for health technology appraisals of immunotherapy, as the committee recommended. I am sure that the committee's report will strengthen the proposals and I will liaise with my ministerial colleagues to make sure that they are given the high level of ministerial commitment that they deserve.
	The fourth set of recommendations focused on food. The Food Standards Agency has been running training workshops to raise awareness of food allergy issues among enforcement officers. The noble Lord, Lord May, also raised the issue of the peanut allergy. The evidence base on avoidance of peanuts in early life and the subsequent development of peanut allergy has changed since the Government issued advice in 1998. The Food Standards Agency has therefore commissioned a review of the scientific evidence that has become available since that time. This adds to the study being conducted by Professor Lack—until recently, a colleague of mine at Imperial who has now moved to King's—which is due to finish in 2012.
	The noble Lord, Lord May, also raised the issue of how we could get a stronger coalition to tackle some of the research needs in this area. The UK Clinical Research Collaboration exists to co-ordinate strategic approaches to research funding. The major funders of this scheme include the Department of Health, industry, research councils and charities—including the Wellcome Trust. I have no doubt that, through the leadership of OSCA, we can bring the debate around research and development in allergy very much to the forefront of the CRCs.
	Finally, the committee recommended that the Department for Children, Schools and Families should review the care and support that children suffering from hay fever receive in schools, particularly through the exam period, as the noble Lord, Lord McColl, highlighted. The Joint Council for Qualifications already advises examination boards that pupils who suffer from hay fever may be given special consideration when taking examinations. We may have to reinforce that. Government guidelines clearly exist; the matter is addressed in Managing Medicines in Schools and Early Years Settings.
	Let me move on to some of the other issues that were raised during this informative debate. The noble Baroness, Lady Perry, referred to EpiPens in schools. Managing Medicines in Schools and Early Years Settings states that early years settings, schools, local authorities and primary care trusts should,
	"review their current policies and procedures",
	to,
	"ensure that all school staff are clear about what to do in ... a medical emergency".
	In relation to allergies or anaphylactic shocks in the school setting, it says that, although the Government do not expect school staff to be medical professionals, those giving or helping with medical treatment should be trained and insured to do so. It is for local authorities and schools to work with primary care trusts to ensure that staff, including school nurses, are trained in the appropriate methods.
	The noble Lord, Lord Rea, and the noble Baroness, Lady Barker, asked how we could improve food allergen labelling and referred to the UK's influence on the EU review. The Food Standards Agency will negotiate the new EU proposal on behalf of the UK Government to ensure that allergic consumers are able to make informed choices about the foods that are safe for them.
	The noble Lord, Lord Colwyn, and the noble Baroness, Lady Barker, talked about the important role of complementary medicine in relation to allergic conditions. Some might be aware of the steering group on the statutory regulation of acupuncture, herbal medicine and traditional Chinese medicine, chaired by Professor Pittilo, which is due to report to Ministers shortly. We will consider the next steps forward in light of the working group's recommendations. I have no doubt that its recommendations will also be of great interest to the all-party parliamentary group.
	The noble Lord, Lord Colwyn, talked about SNOMED—systemised nomenclature of medicine—clinical terminology. The training requirements to ensure the proper use of SNOMED CT relate to the development of detailed care record systems by local service providers as part of the national programme for IT. SNOMED CT is being built into the systems and training will be a local responsibility associated with their deployment. I have no doubt that that will also capture the incidence of allergies out in the community.
	The noble Lord, Lord McColl, also asked about the availability of EpiPens. In the year to 30 September 2006, which is the most recent year for which I have figures, up to 165,000 prescriptions for EpiPens were dispensed in the community in England at a cost of £8 million. EpiPens are out there but I have no doubt that we can do more to ensure that they are there when the need arises, rather than just being prescribed in the community setting.
	In conclusion, the debate this afternoon has raised many important issues about allergies and how the NHS could meet the high standards that patients have a right to expect. I hope that our response to the House of Lords inquiry and the actions that we have taken demonstrate our continued commitment to improving allergy services. I have no doubt that there is more to be done, but I can assure your Lordships that the Government will continue to provide support and encouragement to the health service to ensure that this happens.

Baroness Finlay of Llandaff: My Lords, I am most grateful to all noble Lords who have spoken and covered so many aspects of our report in their excellent speeches. I am also grateful to the Minister for having addressed in detail so many aspects of our debate. Indeed, his speech, which I plan to reread several times, sounded more optimistic than the government response that we received in November last year. For that I am grateful. I am sure that the committee is also grateful to hear that the nettle has been grasped over putting out bids to request a strategic health authority to step up to the plate and consider developing an allergy centre following the hub-and-spokes model that we recommended in our report.
	We heard today that the allergic march continues, and we are coming from a long way behind. Our excellence in research at the basic scientific level needs to be built on and translated into clinical practice. There is an enormous educational job to be done. I pay tribute again to all the committee, who worked absolutely unstintingly. For us, this was not an abstract academic exercise; everyone on the committee worked so hard because they genuinely want to make a difference. The more we went into the subject, the more we were aware of the size of the problem. We were ably supported, especially at the outset, by the scientific analysis from Cathleen Schulte, by Sarah Jones—as was said, this was her first Select Committee and she handled us admirably—and the wise and guiding hand of our special adviser, Professor Barry Kay.
	I reiterate my thanks to everyone and I hope that when a follow-up report is done in a few years' time, we will see a different story being told and that we have turned the corner from the abyss that we found when we started our inquiry.

On Question, Motion agreed to.

Marine Bill (Draft)

A message was brought from the Commons that they concur with the Lords that it is expedient that a Joint Committee of Lords and Commons be appointed to consider and report on any draft Marine Bill presented to both Houses.
	That a Select Committee of 11 Members be appointed to join with the Committee appointed by the Lords to consider the draft Marine Bill.
	That the Committee should report on the draft Bill by 22 July 2008.
	That the Committee shall have power—
	(i) to send for persons, papers and records;
	(ii) to sit notwithstanding any adjournment of the House;
	(iii) to report from time to time;
	(iv) to appoint specialist advisers; and
	(v) to adjourn from place to place within the United Kingdom.
	House adjourned at 7.11 pm.